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Hazen EM, Bartsch BL, Billinger SA. Financial Cost Analysis Associated with a Locomotor Exercise Randomized Controlled Trial in Chronic Stroke. medRxiv 2023:2023.12.20.23300342. [PMID: 38196625 PMCID: PMC10775328 DOI: 10.1101/2023.12.20.23300342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Post-stroke recovery trials pose distinct recruitment and retention challenges, and understanding the financial requirements of conducting randomized controlled trials is crucial to ensure sufficient resources for successful study execution. The purpose of this analysis was to quantify the costs at a single site with a large catchment area of the Moderate-Intensity Exercise Versus High-Intensity Interval Training to Recover Walking Post-Stroke, HIT Stroke Trial. Methods To determine cost, study expense reports were gathered and divided into four categories: oversight, recruitment, retention, and outcome assessments. Categories were then further divided into chronological order for initial contact and prescreening, consenting, initial screening, and baseline testing. The 12-week intervention was divided into 4-week blocks: intervention block 1, post 4-week outcome testing, intervention block 2, post 8-week outcome testing, intervention block 3, and post 12-week outcome testing. Results Total direct cost for site execution was $539,768 with cost per participant approximated as $35,984. Oversight costs accounted for 65.8% of the budget at $355,661. To achieve goals related to inclusive participant recruitment ($21,923) and retention ($28,009), our site costs totaled $49,932. Direct study-related costs included screening assessments ($5,905), baseline assessments ($15,028), intervention ($76,952), and outcome assessments ($36,288). Conclusion Clinical trials on walking rehabilitation and exercise, especially those involving multiple assessment visits, require intensive oversight. This cost analysis provides important and critical insight into the expenses required to successfully execute an exercise-based walking rehabilitation trial in the United States.
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Affiliation(s)
- Emily M. Hazen
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Bria L. Bartsch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS
| | - Sandra A. Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS
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Rapp T, Sicsic J, Ronchetti J, Cicchetti A. Preventing autonomy loss with multicomponent geriatric interventions: A resource-saving strategy? Evidence from the SPRINT-T study. SSM Popul Health 2023; 24:101507. [PMID: 37860705 PMCID: PMC10582469 DOI: 10.1016/j.ssmph.2023.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background The objective of healthy aging strategies is to support interventions targeting autonomy loss prevention, with the assumption that these interventions are likely to be efficient by simultaneously improving clinical outcomes and saving costs. Methods We compare the economic impact of two interventions targeting frailty prevention in older European populations: a multicomponent intervention including physical activity monitoring, nutrition management, information and communications technology use and a relatively simple healthy aging lifestyle education program based on a series of workshops. Our sample includes 1,519 male and female participants from 11 European countries aged 70 years or older. Our econometric model explores trends in several outcomes depending on intervention receipt and frailty status at baseline. Results Implementing a multicomponent intervention among frail older people does not lead to a lower use of care and do not prevent quality of life losses associated with aging. However, it impacts older people's sense of priorities and interest in the future. We find no statistically significant differences between the two interventions, suggesting that the implementation of a multicomponent intervention may not be the most efficient strategy. The impact of the interventions does not differ by frailty status at baseline. Conclusions Our results show the need to implement healthy aging strategies that are more focused on people's interests.
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Affiliation(s)
- Thomas Rapp
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jonathan Sicsic
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
| | - Jérôme Ronchetti
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
| | - Americo Cicchetti
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
| | - SPRINTT consortium
- Université Paris Cité, Chaire AgingUP! and LIRAES (URP 4470), F-75006, Paris, France
- LIEPP Sciences Po Paris, France
- Laboratoire de Recherche Magellan (EA 3713), Université Lyon 3, France
- Università Cattolica del Sacro Cuore, ALTEMS, Faculty of Economics, Rome, Italy
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Larsen B, Gilmer T, Pekmezi D, Hartman SJ, Benitez T, Rabin B, Marcus BH, Mendoza-Vasconez AS, Groessl EJ. Cost effectiveness of a technology-enhanced physical activity intervention for Latinas. Transl Behav Med 2023; 13:675-682. [PMID: 37208924 PMCID: PMC10496433 DOI: 10.1093/tbm/ibad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, AL, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Borsika Rabin
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Erik J Groessl
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- Health Services Research and Development unit, VA San Diego Health Care System, San Diego, CA, USA
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Newman AB. The Epidemiology and Societal Impact of Aging-Related Functional Limitations: A Looming Public Health Crisis. J Gerontol A Biol Sci Med Sci 2023; 78:4-7. [PMID: 37325965 PMCID: PMC10272977 DOI: 10.1093/gerona/glad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Indexed: 06/17/2023] Open
Abstract
Functional impairment and disability become increasingly common with aging. As more people are reaching old age, the number of people needing care will rise, creating a crisis of need for care. Population studies and clinical trials have demonstrated the importance of the detection of early loss of strength and walking speed in predicting disability and in designing interventions to prevent functional decline. There is a large societal burden linked to age-related disorders. Physical activity is to date the only intervention that has prevented disability in a long-term clinical trial, but is difficult to sustain. Novel interventions are needed to maintain function in late life.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania,USA
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Pinheiro MB, Howard K, Oliveira JS, Kwok WS, Tiedemann A, Wang B, Taylor J, Bauman A, Sherrington C. Cost-effectiveness of physical activity programs and services for older adults: a scoping review. Age Ageing 2023; 52:7078344. [PMID: 36934340 PMCID: PMC10024893 DOI: 10.1093/ageing/afad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Evidence supporting physical activity for older adults is strongly positive. Implementation and scale-up of these interventions need to consider the value for money. This scoping review aimed to assess the volume of (i) systematic review evidence regarding economic evaluations of physical activity interventions, and (ii) of cost utility analysis (CUA) studies (trial- or model-based) of physical activity interventions for older people. METHODS We searched five databases (January 2010 to February 2022) for systematic reviews of economic evaluations, and two databases (1976 to February 2022) for CUA studies of physical activity interventions for any population of people aged 60+ years. RESULTS We found 12 potential reviews, two of which were eligible for inclusion. The remaining 10 reviews included eligible individual studies that were included in this review. All individual studies from the 12 reviews (n = 37) investigated the cost-effectiveness of structured exercise and most showed the intervention was more costly but more effective than no intervention. We identified 27 CUA studies: two investigated a physical activity promotion program and the remainder investigated structured exercise. Most interventions (86%) were more costly but more effective, and the remaining were cost-saving compared to no intervention. CONCLUSIONS There is a scarcity of reviews investigating the value for money of physical activity interventions for older adults. Most studies investigated structured exercise. Physical activity interventions were generally more effective than no intervention but more costly. As such an intervention could be cost-effective and therefore worthy of wider implementation, but there is a need for more frequent economic evaluation in this field.
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Affiliation(s)
| | - Kirsten Howard
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Juliana S Oliveira
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Wing S Kwok
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne Tiedemann
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Belinda Wang
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jennifer Taylor
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Snowsill T, Johansen-Berg H, Bilzon J, Gray S, Cross R, Western MJ, Koning JLD, Ladlow P, Bollen JC, Moorlock SJ, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT. Public Health Res 2022. [DOI: 10.3310/mqbw6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background
Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.
Objective
The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Design
A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.
Setting
Urban and semi-rural locations across three sites in England.
Participants
Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.
Interventions
Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.
Main outcome measures
The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.
Results
Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.
Conclusion
A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.
Limitations
Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.
Future work
Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.
Trial registration
This trial is registered as ISRCTN45627165.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Tristan Snowsill
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Rosina Cross
- Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - Jessica C Bollen
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Centre, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Cabral DF, Santos VS, Silva MJG, Leite GF, Mesquita APB, Pascual-Leone A, Cahalin LP, Batiston AP, Oliveira ACA, Gomes-Osman J. Recommending Physical Activity to Your Aging Patients? What Clinicians Need to Know to Increase Adherence From the Older Adult Perspective. Front Rehabilit Sci 2022; 3:923221. [PMID: 36189000 PMCID: PMC9397884 DOI: 10.3389/fresc.2022.923221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
A wealth of scientific evidence supports that being physically active may prevent or delay the onset of cognitive impairment and dementia. However, a critical barrier is that while most clinicians recommend physical activity (PA) and older adults recognize its health benefits, most older adults fail to regularly practice PA. Thus, it is necessary to explore and disseminate knowledge on how to help clinicians truly partner with people and help them to change their behavior and become more active. Clinical and scientific efforts are underway to establish dose-specific PA recommendations for cognitive brain health. However, an important knowledge gap is how to develop effective strategies to increase PA adherence in aging. To better understand the perspective of older adults, we undertook a mixed-method study on sixty-five sedentary older adults at risk for cognitive decline. Participants answered a questionnaire battery related to PA engagement, and a subcohort participated in a remote focus group. Our findings revealed four main themes: First, age and aging are determinants in PA practice. Second, maintaining both an active mind and autonomy are priorities, but planned PA is not usually related as part of being “active.” Third, motivational challenges in PA engagement were noted. And fourth, they emphasized a call for tailored recommendations. Therefore, we present a multidimensional model of PA adherence to maximize brain health in older adults and suggest a tool kit and key questions to effectively screen sedentary aging adults and translate current guidelines into the needs of the individual by using behavior change strategies.
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Affiliation(s)
- Danylo F. Cabral
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
| | - Vinicius S. Santos
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Maria Jasmine G. Silva
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Gabriela F. Leite
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
| | - Ana Paula B. Mesquita
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
| | - Alvaro Pascual-Leone
- Guttmann Brain Health Institute, Institut Universitari de Neurorehabilitació, Barcelona, Spain
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Linus Health, Waltham, MA, United States
| | - Lawrence P. Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Augusto C. A. Oliveira
- Research Group on Human Aging, Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Brazil
| | - Joyce Gomes-Osman
- Linus Health, Waltham, MA, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Joyce Gomes-Osman
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Crist K, Full KM, Linke S, Tuz-Zahra F, Bolling K, Lewars B, Liu C, Shi Y, Rosenberg D, Jankowska M, Benmarhnia T, Natarajan L. Health effects and cost-effectiveness of a multilevel physical activity intervention in low-income older adults; results from the PEP4PA cluster randomized controlled trial. Int J Behav Nutr Phys Act 2022; 19:75. [PMID: 35761363 PMCID: PMC9235144 DOI: 10.1186/s12966-022-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background Older adults are the least active population in the U.S. Low-income communities have fewer physical activity (PA) resources, contributing to less PA and increased chronic disease risk. This study assessed the effect of the multilevel, peer-led, Peer Empowerment Program 4 Physical Activity (PEP4PA) on moderate-to-vigorous PA (MVPA) and health outcomes, over 2 years of follow up. Methods In a cluster-randomized controlled trial, 12 senior or community centers serving low-income older adults were assigned to a PA intervention (n = 6) or usual programming (n = 6) condition. PEP4PA included self-monitoring, health coaching, group walks, social support, and community advocacy to improve walking conditions. The primary outcome was daily minutes of MVPA (7-day accelerometer). Secondary outcomes included Perceived Quality of Life (PQoL), 6-Minute Walk Test (6-MWT), blood pressure (BP), and depressive symptoms at baseline, 6, 12, 18 and 24 months. Mixed effects regression models estimated the effects on outcomes between groups over time and included random effects for repeated measures and center clustering. Effect modification by sex and income status was assessed. We calculated the incremental cost per daily minute of MVPA gained in the intervention group relative to the control group to assess cost effectiveness. Results We enrolled 476 older adults (50 + years). Participants were on average 71 years old, 76% female, 60% low income, and 38% identified as racial or ethnic minorities. Compared to the control group, intervention participants sustained roughly a 10 min/day increase in MVPA from baseline at all time points and increased mean PQoL scores from unsatisfied at baseline to satisfied at 12, 18 and 24 months. Males and higher-income groups had greater improvements in MVPA. No significant effects were observed for 6-MWT or depressive symptoms, and BP results were mixed. The incremental cost per minute MVPA gained per person was $0.25, $0.09, $0.06, and $0.05 at 6, 12, 18 and 24 months, respectively. Conclusions PEP4PA achieved increases in MVPA and PQoL in low-income older adults, over 2 years of follow up. The peer-led, community-based intervention provides a sustainable and cost-effective model to improve health behaviors in underserved, aging populations. Trial registration ClinicalTrials.gov (NCT02405325) March 20, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01309-w.
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Affiliation(s)
- Katie Crist
- Department of Urban Studies & Planning, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Kelsie M Full
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Minneapolis, MN, 55415, USA
| | - Sarah Linke
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Fatima Tuz-Zahra
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Khalisa Bolling
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Brittany Lewars
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Chenyu Liu
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Dori Rosenberg
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
| | - Marta Jankowska
- Population Sciences, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Loki Natarajan
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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9
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Gill TM. Preserving community mobility in vulnerable older people. BMJ 2022; 377:o1084. [PMID: 35545267 DOI: 10.1136/bmj.o1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Snowsill TM, Stathi A, Green C, Withall J, Greaves CJ, Thompson JL, Taylor G, Gray S, Johansen-Berg H, Bilzon JLJ, de Koning JL, Bollen JC, Moorlock SJ, Western MJ, Guralnik JM, Rejeski WJ, Fox KR, Medina-Lara A. Cost-effectiveness of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: an economic evaluation of the REACT (Retirement in Action) trial. Lancet Public Health 2022; 7:e327-34. [PMID: 35325628 DOI: 10.1016/S2468-2667(22)00030-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in older adults at increased risk of mobility limitation. We aimed to do an economic evaluation of the REACT trial to investigate whether the intervention is cost-effective. METHODS In this health economic evaluation, we did cost-effectiveness and cost-utility analyses of the REACT programme versus standard care on the basis of resource use, primary outcome, and health-related quality-of-life data measured in the REACT trial. We also developed a decision analytic Markov model that forecasts the mobility of recipients beyond the 24-month follow-up of the trial and translated this into future costs and potential benefit to health-related quality of life using the National Health Service and Personal Social Services perspective. Participants completed questionnaire booklets at baseline, and at 6, 12, and 24 months after randomisation, which included a resource use questionnaire and the EQ-5D-5L and 36-item short-form survey (SF-36) health-related quality-of-life instruments. The cost of delivering the intervention was estimated by identifying key resources, such as REACT session leader time, time of an individual to coordinate the programme, and venue hire. EQ-5D-5L and SF-36 responses were converted to preference-based utility values, which were used to estimate quality-adjusted life-years (QALYs) over the 24-month trial follow-up using the area-under-the-curve method. We used generalised linear models to examine the effect of the REACT programme on costs and QALYs and adjust for baseline covariates. Costs and QALYs beyond 12 months were discounted at 3·5% per year. This is a pre-planned analysis of the REACT trial; the trial itself is registered with ISRCTN (ISRCTN45627165). FINDINGS The 12-month REACT programme was estimated to cost £622 per recipient to deliver. The most substantial cost components are the REACT session leader time (£309 per participant), venue hire (£109), and the REACT coordinator time (£80). The base-case analysis of the trial-based economic evaluation showed that reductions in health and social care usage due to the REACT programme could offset the REACT delivery costs (£3943 in the intervention group vs £4043 in the control group; difference: -£103 [95% CI -£695 to £489]) with a health benefit of 0·04 QALYs (0·009-0·071; 1·354 QALYs in the intervention group vs 1·314 QALYs in the control group) within the 24-month timeframe of the trial. INTERPRETATION The REACT programme could be considered a cost-effective approach for improving the health-related quality of life of older adults at risk of mobility limitations. FUNDING National Institute for Health Research Public Health Research Programme.
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Cabral DF, Santos VS, Pereira OTT, Silva MJ, Pascual-Leone A, Rundek T, Loewenstein DA, Kirk-Sanchez N, Oliveira ACA, Gomes-Osman J. Feasibility and Preliminary Efficacy of a Multimodal Approach to Increase Physical Activity in Older Adults With Memory Complaints: The Education for Action Study. J Aging Phys Act 2021;:1-13. [PMID: 34412033 DOI: 10.1123/japa.2020-0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
In this randomized controlled pilot trial, the authors explored the feasibility, technology compliance, and preliminary efficacy of the Education for Action (EDU-ACT), a multimodal intervention combining evidence-based strategies of physical activity (PA) education and coaching in PA levels over 4 weeks between EDU-ACT and control groups. The authors also assessed pre-post changes in neurocognitive function, functional mobility and dual-task performance, sleep and quality of life. Thirty-two sedentary older adults with memory complaints (age = 66 ± 5.3) completed the study (EDU-ACT = 18 and control = 14). The EDU-ACT adherence rate was 95%, and compliance of daily PA reporting was, on average, 22.7 days (94.6%). The EDU-ACT group demonstrated a significantly greater number of steps, processing speed, and dual-task performance when compared with controls (p < .05). In this study, a multimodal, evidence-based, low-cost intervention was feasible, well-accepted, with high adherence and compliance rates, and effective at promoting clinically meaningful increases in PA, for at least 1 month postintervention, in older adults with memory complaints.
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Wilson KE, Michaud TL, Almeida FA, Schwab RJ, Porter GC, Aquilina KH, Brito FA, Golden CA, Dressler EV, Kittel CA, Harvin LN, Boggs AE, Katula JA, Estabrooks PA. Using a population health management approach to enroll participants in a diabetes prevention trial: reach outcomes from the PREDICTS randomized clinical trial. Transl Behav Med 2021; 11:1066-1077. [PMID: 33677529 PMCID: PMC8158170 DOI: 10.1093/tbm/ibab010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Population health management (PHM) strategies to address diabetes prevention have the potential to engage large numbers of at-risk individuals in a short duration. We examined a PHM approach to recruit participants to a diabetes prevention clinical trial in a metropolitan health system. We examined reach and representativeness and assessed differences from active and passive respondents to recruitment outreach, and participants enrolled through two clinical screening protocols. The PHM approach included an electronic health record (EHR) query, physician review of identified patients, letter invitation, and telephone follow-up. Data describe the reach and representativeness of potential participants at multiple stages during the recruitment process. Subgroup analyses examined proportional reach, participant differences based on passive versus active recruitment response, and clinical screening method used to determine diabetes risk status. The PHM approach identified 10,177 potential participants to receive a physician letter invitation, 60% were contacted by telephone, 2,796 (46%) completed telephone screening, 1,961 were eligible from telephone screen, and 599 were enrolled in 15 months. Accrual was unaffected by shifting clinical screening protocols despite the increase in participant burden. Relative to census data, study participants were more likely to be obese, female, older, and Caucasian. Relative to the patient population, enrolled participants were less likely to be Black and were older. Active respondents were more likely to have a higher income than passive responders. PHM strategies have the potential to reach a large number of participants in a relatively short period, though concerted efforts are needed to increase participant diversity.
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Affiliation(s)
- Kathryn E Wilson
- Department of Kinesiology and Health, College of Education and Human Development, Georgia State University, Sports Arena, Atlanta, GA, USA.,Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fabio A Almeida
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert J Schwab
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Internal Medicine Division of General Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gwenndolyn C Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn H Aquilina
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fabiana A Brito
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin A Golden
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lea N Harvin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley E Boggs
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Paul A Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Dos Santos V, Muniz C, Gobbo L. Influence of physical activity with moderate and vigorous intensities on the muscle strength of dynapenic older adults: Prospective study. Sci Sports 2021; 36:218-224. [DOI: 10.1016/j.scispo.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Donahue PT, Grove G, Stillman C, Kang C, Burns J, Hillman CH, Kramer AF, McAuley E, Vidoni E, Erickson KI. Estimating the financial costs associated with a phase III, multi-site exercise intervention trial: Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE). Contemp Clin Trials 2021; 105:106401. [PMID: 33857678 DOI: 10.1016/j.cct.2021.106401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Supervised exercise interventions are expensive and time intensive. However, there are financial costs to consider in addition to the intervention itself, namely: advertising and recruitment, outcome assessments, and other trial-related costs. OBJECTIVES In this analysis, we examine the financial costs associated with the administration of Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) to quantify the costs associated with large exercise intervention trials and to provide future investigators with financial estimates if they wish to pursue studies of a similar design. METHODS Cost per randomized participant were calculated in four areas: (1) advertising and recruitment, (2) outcome assessments, (3) delivery of the intervention, and (4) other trial-related expenses. Overall trial costs associated with data analysis, faculty salaries, and indirect costs were estimated as well. RESULTS The total cost per randomized participant was estimated to be $16,494. Outcome assessments accounted for the highest proportion of per-participant (75%) and total trial (38%) costs. Neuroimaging assessments (MRI & PET) cost $8247 per randomized participant, accounting for two-thirds (67%) of outcome assessment costs and half (50%) of per-participant costs. CONCLUSION Large clinical trials of exercise are expensive (~$21 million), particularly when administering several visits to assess study aims. Outcome assessments, specifically those involving neuroimaging, accounted for a significant proportion of total costs in this analysis. Future investigators must budget accordingly if they wish to conduct a comprehensive, multi-site exercise intervention trial that examines numerous physiological and psychological outcomes.
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Affiliation(s)
- Patrick T Donahue
- University of Pittsburgh, Pittsburgh, PA, USA; Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | - Jeffrey Burns
- University of Kansas Medical Center, Kansas City, MO, USA
| | | | - Arthur F Kramer
- Northeastern University, Boston, MA, USA; University of Illinois, Champaign, IL, USA
| | | | - Eric Vidoni
- University of Kansas Medical Center, Kansas City, MO, USA
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Brown JD, Wang CY, Groessl EJ, Pahor M, Manini TM. Three-Year, Postintervention, Follow-up Comparison of Health Care Resource Utilization and Costs in the Lifestyle Interventions and Independence for Elders (LIFE) Study. J Gerontol A Biol Sci Med Sci 2021; 76:272-276. [PMID: 32270182 DOI: 10.1093/gerona/glaa088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity (PA) intervention was found to be cost-effective compared to health education (HE). However, long-term effects postintervention are unknown. METHOD This was a secondary analysis of LIFE Study data linked to Medicare claims data (2014-2016). Participants were linked via Social Security Numbers to Medicare claims data. Utilization and cost variables were analyzed using generalized linear models with negative binomial and Tweedie distributions. Unadjusted means and 95% confidence intervals were compared by year and overall stratified. Each model compared PA versus HE and adjusted for other baseline characteristics and stratified by study site. Additional models were stratified by baseline physical functioning assessment scores. RESULTS Of the 1,635 LIFE Study participants, 804 (53.5%) were linked to Medicare claims with an average of 33 months of follow-up time during the 3-year data linkage period. Mean outpatient (6.6 vs 6.8), inpatient (0.40 vs 0.40), and other utilization metrics were similar between PA and HE groups. Costs were also similar for each group and each type of service, for example, outpatient: $2,070 versus $2,093 and inpatient: $4,704 versus $4,792. Regression results indicated no statistically significant differences between PA and HE groups. CONCLUSIONS While the LIFE Study demonstrated that PA reduced mobility disability in older adults and was cost-effective, it did not appear to affect long-term health care utilization costs posttrial. These findings suggest that it remains challenging to affect long-term health care costs using PA interventions effects.
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Affiliation(s)
- Joshua D Brown
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville.,Center for Drug Evaluation & Safety, University of Florida, Gainesville
| | - Ching-Yu Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville
| | - Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla.,VA San Diego Healthcare System, California
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville.,Institute on Aging, University of Florida, Gainesville
| | - Todd M Manini
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville.,Institute on Aging, University of Florida, Gainesville
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Blanc RS, Kallenbach JG, Bachman JF, Mitchell A, Paris ND, Chakkalakal JV. Inhibition of inflammatory CCR2 signaling promotes aged muscle regeneration and strength recovery after injury. Nat Commun 2020; 11:4167. [PMID: 32820177 PMCID: PMC7441393 DOI: 10.1038/s41467-020-17620-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
Muscle regeneration depends on a robust albeit transient inflammatory response. Persistent inflammation is a feature of age-related regenerative deficits, yet the underlying mechanisms are poorly understood. Here, we find inflammatory-related CC-chemokine-receptor 2 (Ccr2) expression in non-hematopoietic myogenic progenitors (MPs) during regeneration. After injury, the expression of Ccr2 in MPs corresponds to the levels of its ligands, the chemokines Ccl2, 7, and 8. We find stimulation of Ccr2-activity inhibits MP fusion and contribution to myofibers. This occurs in association with increases in MAPKp38δ/γ signaling, MyoD phosphorylation, and repression of the terminal myogenic commitment factor Myogenin. High levels of Ccr2-chemokines are a feature of regenerating aged muscle. Correspondingly, deletion of Ccr2 in MPs is necessary for proper fusion into regenerating aged muscle. Finally, opportune Ccr2 inhibition after injury enhances aged regeneration and functional recovery. These results demonstrate that inflammatory-induced activation of Ccr2 signaling in myogenic cells contributes to aged muscle regenerative decline. Chronic inflammation is a feature of age-related regenerative decline in skeletal muscles, but how it directly affects resident muscle stem cell fate and function is unclear. Here, the authors show that Ccr2 signaling in muscle stem cell derived progenitors represses terminal myogenic differentiation, and that targeting Ccr2 on aged myogenic progenitors rejuvenates aged skeletal muscle healing and function.
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Affiliation(s)
- Roméo S Blanc
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA.,Wilmot Cancer Institute, Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Jacob G Kallenbach
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, USA
| | - John F Bachman
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pathology and Laboratory Medicine, Cell Biology of Disease Graduate Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Amanda Mitchell
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Nicole D Paris
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA.,Wilmot Cancer Institute, Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Joe V Chakkalakal
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY, USA. .,Wilmot Cancer Institute, Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical Center, Rochester, NY, USA. .,Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, USA.
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Suikkanen SA, Soukkio PK, Aartolahti EM, Kautiainen H, Kääriä SM, Hupli MT, Sipilä S, Pitkälä KH, Kukkonen-Harjula KT. Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial. J Am Med Dir Assoc 2020; 22:773-779. [PMID: 32694001 DOI: 10.1016/j.jamda.2020.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Frailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. DESIGN Randomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. SETTING AND PARTICIPANTS A sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17. METHODS Primary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. RESULTS The participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98-1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23-1.98), and after 24 months, 1.23-fold (95% CI 0.95-1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004). CONCLUSIONS AND IMPLICATIONS Physical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.
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Affiliation(s)
- Sara A Suikkanen
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Paula K Soukkio
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva M Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, University of Helsinki, Department of General Practice, and Helsinki University Hospital, Helsinki, Finland
| | | | - Markku T Hupli
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Kaisu H Pitkälä
- Unit of Primary Health Care, University of Helsinki, Department of General Practice, and Helsinki University Hospital, Helsinki, Finland
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Hetherington S, Swinton P, Henwood T, Keogh J, Gardiner P, Tuckett A, Rouse K, Comans T. Progressive Resistance Plus Balance Training for Older Australians Receiving In-Home Care Services: Cost-Effectiveness Analyses Alongside the Muscling Up Against Disability Stepped-Wedge Randomized Control Trial. J Aging Phys Act 2020; 28:352-359. [PMID: 31722295 DOI: 10.1123/japa.2019-0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022]
Abstract
In this article, the authors assessed the cost-effectiveness of center-based exercise training for older Australians. The participants were recipients of in-home care services, and they completed 24 weeks of progressive resistance plus balance training. Transport was offered to all participants. A stepped-wedge randomized control trial produced pre-, post-, and follow-up outcomes and cost data, which were used to calculate incremental cost-effectiveness ratios per quality-adjusted life year gained. Analyses were conducted from a health provider perspective and from a government perspective. From a health-service provider perspective, the direct cost of program provision was $303 per person, with transport adding an additional $1,920 per person. The incremental cost-utility ratio of the program relative to usual care was $70,540 per quality-adjusted life year over 6 months, decreasing to $37,816 per quality-adjusted life year over 12 months. The findings suggest that Muscling Up Against Disability offers good value for the money within commonly accepted threshold values.
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Ha D, Kerr J, Ries AL, Fuster MM, Lippman SM, Murphy JD. A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors After Curative-Intent Treatment. Am J Phys Med Rehabil 2020; 99:233-40. [PMID: 31361623 DOI: 10.1097/PHM.0000000000001281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors. DESIGN We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders exercise intervention compared with usual care for stage I-IIIA lung cancer survivors after curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios of less than US $100,000/quality-adjusted life-year as cost-effective and assessed model uncertainty using sensitivity analyses. RESULTS The base-case model showed that the Lifestyle Interventions and Independence for Elders exercise program would increase overall cost by US $4740 and effectiveness by 0.06 quality-adjusted life-years compared with usual care and have an incremental cost-effectiveness ratio of US $79,504/quality-adjusted life-year. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of US $100,000/quality-adjusted life-year, Lifestyle Interventions and Independence for Elders had a 71% probability of being cost-effective compared with 27% for usual care. When we included opportunity costs, Lifestyle Interventions and Independence for Elders had an incremental cost-effectiveness ratio of US $179,774/quality-adjusted life-year, exceeding the cost-effectiveness threshold. CONCLUSIONS A simulation of the Lifestyle Interventions and Independence for Elders exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective.
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LaCroix AZ, LaMonte MJ, Applegate WB. The Long View of the LIFE Trial and a Life's Work. J Am Geriatr Soc 2020; 68:686-688. [PMID: 32105349 DOI: 10.1111/jgs.16374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Z LaCroix
- Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, New York
| | - William B Applegate
- Sticht Center on Aging, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Pahor M, Guralnik JM, Anton SD, Ambrosius WT, Blair SN, Church TS, Espeland MA, Fielding RA, Gill TM, Glynn NW, Groessl EJ, King AC, Kritchevsky SB, Manini TM, McDermott MM, Miller ME, Newman AB, Williamson JD. Impact and Lessons From the Lifestyle Interventions and Independence for Elders (LIFE) Clinical Trials of Physical Activity to Prevent Mobility Disability. J Am Geriatr Soc 2020; 68:872-881. [PMID: 32105353 PMCID: PMC7187344 DOI: 10.1111/jgs.16365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Walking independently is basic to human functioning. The Lifestyle Interventions and Independence for Elders (LIFE) studies were developed to assess whether initiating physical activity could prevent major mobility disability (MMD) in sedentary older adults. METHODS We review the development and selected findings of the LIFE studies from 2000 through 2019, including the planning phase, the LIFE-Pilot Study, and the LIFE Study. RESULTS The planning phase and the LIFE-Pilot provided key information for the successful implementation of the LIFE Study. The LIFE Study, involving 1635 participants randomized at eight sites throughout the United States, showed that compared with health education, the physical activity program reduced the risk of the primary outcome of MMD (inability to walk 400 m: hazard ratio = 0.82; 95% confidence interval = 0.69-0.98; P = .03), and that the intervention was cost-effective. There were no significant effects on cognitive outcomes, cardiovascular events, or serious fall injuries. In addition, the LIFE studies provided relevant findings on a broad range of other outcomes, including health, frailty, behavioral outcomes, biomarkers, and imaging. To date, the LIFE studies have generated a legacy of 109 peer-reviewed publications, 19 ancillary studies, and 38 independently funded grants and clinical trials, and advanced the development of 59 early career scientists. Data and biological samples of the LIFE Study are now publicly available from a repository sponsored by the National Institute on Aging (https://agingresearchbiobank.nia.nih.gov). CONCLUSIONS The LIFE studies generated a wealth of important scientific findings and accelerated research in geriatrics and gerontology, benefiting the research community, trainees, clinicians, policy makers, and the general public. J Am Geriatr Soc 68:872-881, 2020.
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Affiliation(s)
- Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Jack M Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Walter T Ambrosius
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, South Carolina
| | | | - Mark A Espeland
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erik J Groessl
- VA San Diego Healthcare System and Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California
| | - Abby C King
- Department of Health Research and Policy (Epidemiology) and of Medicine (Stanford Prevention Research Center), Stanford University, School of Medicine, Stanford, California
| | - Stephen B Kritchevsky
- Department of Internal Medicine and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E Miller
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff D Williamson
- Department of Internal Medicine and the Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Barrett S, Begg S, O'Halloran P, Kingsley M. Cost-effectiveness of telephone coaching for physically inactive ambulatory care hospital patients: economic evaluation alongside the Healthy4U randomised controlled trial. BMJ Open 2019; 9:e032500. [PMID: 31826893 PMCID: PMC6924747 DOI: 10.1136/bmjopen-2019-032500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess whether telephone coaching is a cost-effective method for increasing physical activity and health-related quality of life for insufficiently active adults presenting to an ambulatory care clinic in a public hospital. DESIGN An economic evaluation was performed alongside a randomised controlled trial. SETTING Participants were recruited from an ambulatory care clinic in a public hospital in regional Australia. PARTICIPANTS Seventy-two adults (aged 18-69) deemed insufficiently physically active via self-report. INTERVENTIONS Participants were randomised to either an intervention group that received an education session and eight sessions of telephone coaching over a 12-week period, or to a control group that received the education session only. The intervention used in the telephone coaching was integrated motivational interviewing and cognitive behavioural therapy. OUTCOME MEASURES The primary health outcome was change in moderate-to-vigorous physical activity (MVPA), objectively measured via accelerometry. The secondary outcome was the quality-adjusted life-year (QALY) determined by the 12-item Short Form Health Survey Questionnaire. Outcome data were measured at baseline, postintervention (3 months) and follow-up (6 months). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty. RESULTS The mean intervention cost was $279±$13 per person. At 6 months follow-up, relative to control, the intervention group undertook 18 more minutes of daily MVPA at an ICER of $15/min for each additional minute of MVPA. With regard to QALYs, the intervention yielded an ICER of $36 857 per QALY gained. Sensitivity analyses indicated that results were robust to varied assumptions. CONCLUSION Telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently physically active ambulatory care hospital patients. Additional research could explore the potential economic impact of the intervention from a broader healthcare perspective. TRIAL REGISTRATION NUMBER ANZCTR: ACTRN12616001331426.
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Affiliation(s)
- Stephen Barrett
- Health Promotion, Bendigo Health - Bendigo Hospital Campus, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Holsworth Research Initiative, La Trobe University, Bendigo, Victoria, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Kingsley
- La Trobe Holsworth Research Initiative, La Trobe University, Bendigo, Victoria, Australia
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Montano M, Bhasin S, D'Aquila RT, Erlandson KM, Evans WJ, Funderburg NT, Justice A, Ndhlovu LC, Ojikutu B, Pahor M, Pahwa S, Ryan AS, Schrack J, Schultz MB, Sebastiani P, Sinclair DA, Tripp J, Walker B, Womack JA, Yung R, Reeves RK. Harvard HIV and Aging Workshop: Perspectives and Priorities from Claude D. Pepper Centers and Centers for AIDS Research. AIDS Res Hum Retroviruses 2019; 35:999-1012. [PMID: 31456412 DOI: 10.1089/aid.2019.0130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
People aging with HIV (PAWH) infection experience greater impairments in physical and cognitive function, in addition to higher rates of peripheral comorbid conditions (e.g., renal failure, diabetes, bone fracture, hypertension, cardiovascular disease, polypharmacy, and multimorbidity). While multifactorial drivers, including HIV infection itself, antiretroviral therapy-related toxicities, disparities in care, and biobehavioral factors, likely contribute, there remains an overarching question as to what are the relevant age-related mechanisms and models that could inform interventions that promote health span and life span in PAWH? This workshop was convened to hear from experts on the biology of aging and HIV researchers studying PAWH to focus on advancing investigations at the interface of HIV and Aging. In this study, we summarize the discussions from the Harvard Center for AIDS Research and Boston Claude D. Pepper cosponsored workshop on HIV and Aging, which took place in October 2018.
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Affiliation(s)
- Monty Montano
- Boston Pepper OAIC, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shalender Bhasin
- Boston Pepper OAIC, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, California
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, Ohio
| | - Amy Justice
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lishomwa C Ndhlovu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Bisola Ojikutu
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida
| | - Savita Pahwa
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alice S Ryan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Baltimore Veterans Affairs Geriatric Research Education and Clinical Center and Research and Development Service, Baltimore, Maryland
| | - Jennifer Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael B Schultz
- Department of Genetics, Paul F. Glenn Labs for the Biology of Aging, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Paola Sebastiani
- Department of Biostatistics, Boston University, Boston, Massachusetts
| | - David A Sinclair
- Department of Genetics, Paul F. Glenn Labs for the Biology of Aging, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Julia Tripp
- Harvard University Center for AIDS Research, Cambridge, Massachusetts
| | - Bruce Walker
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
| | - Julie A Womack
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Nursing, West Haven, Connecticut
| | - Raymond Yung
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - R Keith Reeves
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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24
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Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, Glynn NW, King AC, Anton SD, Walkup M, Lu CJ, Reid K, Spring B, Pahor M. Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. Am J Prev Med 2019; 56:141-146. [PMID: 30573142 PMCID: PMC6309909 DOI: 10.1016/j.amepre.2018.09.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Older adults are a rapidly growing segment of the U.S. POPULATION Mobility problems that lead to further disability can be addressed through physical activity interventions. Quality of life outcome results are reported from a large trial of physical activity for sedentary older adults at risk for mobility disability. METHODS Data were from the Lifestyle Interventions and Independence for Elders study. This multisite RCT compared physical activity to health education among 1,635 randomly assigned sedentary older adults at risk for mobility disability in 2010-2011. Measures included demographics; comorbidity; a timed 400-meter walk; the Short Physical Performance Battery; and the Quality of Well-Being Scale (0-1.0 scale). Baseline and long-term follow-up (2.6 years) health-related quality of life data were collected as a secondary outcome. Multivariate linear regression modeling was used to examine covariates of health-related quality of life over time in 2017. RESULTS The sample had an overall mean Quality of Well-Being score of 0.613. Both groups declined in quality of life over time, but assignment to the physical activity intervention resulted in a slower decline in health-related quality of life scores (p=0.03). Intervention attendance was associated with higher health-related quality of life for both groups. Baseline characteristics including younger age, fewer comorbid conditions, non-white ethnicity, and faster 400-meter walk times were also associated with higher health-related quality of life over time. CONCLUSIONS Declining mobility measured by physical performance is associated with lower quality of life in sedentary older adults. Physical activity interventions can slow the decline in quality of life, and targeting specific subgroups may enhance the effects of such interventions.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Health Services Research and Development Unit, VA San Diego Healthcare System, San Diego, California.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Jeffrey A Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abby C King
- Department of Health Research and Policy and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Michael Walkup
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Ching-Ju Lu
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Kieran Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Tufts University, Boston, Massachusetts
| | - Bonnie Spring
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
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Deidda M, Coll-Planas L, Giné-Garriga M, Guerra-Balic M, Roqué i Figuls M, Tully MA, Caserotti P, Rothenbacher D, Salvà Casanovas A, Kee F, Blackburn NE, Wilson JJ, Skjødt M, Denkinger M, Wirth K, McIntosh E. Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ Open 2018; 8:e022266. [PMID: 30327403 PMCID: PMC6194476 DOI: 10.1136/bmjopen-2018-022266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Promoting physical activity (PA) and reducing sedentary behaviour (SB) may exert beneficial effects on the older adult population, improving behavioural, functional, health and psychosocial outcomes in addition to reducing health, social care and personal costs. This paper describes the planned economic evaluation of SITLESS, a multicountry three-armed pragmatic randomised controlled trial (RCT) which aims to assess the short-term and long-term effectiveness and cost-effectiveness of a complex intervention on SB and PA in community-dwelling older adults, based on exercise referral schemes enhanced by a group intervention providing self-management strategies to encourage lifestyle change. METHODS AND ANALYSIS A within-trial economic evaluation and long-term model from both a National Health Service/personal social services perspective and a broader societal perspective will be undertaken alongside the SITLESS multinational RCT. Healthcare costs (hospitalisations, accident and emergency visits, appointment with health professionals) and social care costs (eg, community care) will be included in the economic evaluation. For the cost-utility analysis, quality-adjusted life-years will be measured using the EQ-5D-5L and capability well-being measured using the ICEpop CAPability measure for Older people (ICECAP-O) questionnaire. Other effectiveness outcomes (health related, behavioural, functional) will be incorporated into a cost-effectiveness analysis and cost-consequence analysis.The multinational nature of this RCT implies a hierarchical structure of the data and unobserved heterogeneity between clusters that needs to be adequately modelled with appropriate statistical and econometric techniques. In addition, a long-term population health economic model will be developed and will synthesise and extrapolate within-trial data with additional data extracted from the literature linking PA and SB outcomes with longer term health states.Methods guidance for population health economic evaluation will be adopted including the use of a long-time horizon, 1.5% discount rate for costs and benefits, cost consequence analysis framework and a multisector perspective. ETHICS AND DISSEMINATION The study design was approved by the ethics and research committee of each intervention site: the Ethics and Research Committee of Ramon Llull University (reference number: 1314001P) (Fundació Blanquerna, Spain), the Regional Committees on Health Research Ethics for Southern Denmark (reference number: S-20150186) (University of Southern Denmark, Denmark), Office for Research Ethics Committees in Northern Ireland (ORECNI reference number: 16/NI/0185) (Queen's University of Belfast) and the Ethical Review Board of Ulm University (reference number: 354/15) (Ulm, Germany). Participation is voluntary and all participants will be asked to sign informed consent before the start of the study.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634 270. This article reflects only the authors' view and the Commission is not responsible for any use that may be made of the information it contains.The findings of the study will be disseminated to different target groups (academia, policymakers, end users) through different means following the national ethical guidelines and the dissemination regulation of the Horizon 2020 funding agency.Use of the EuroQol was registered with the EuroQol Group in 2016.Use of the ICECAP-O was registered with the University of Birmingham in March 2017. TRIAL REGISTRATION NUMBER NCT02629666; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
| | - Laura Coll-Planas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Míriam Guerra-Balic
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Marta Roqué i Figuls
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Mark A Tully
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | | | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Frank Kee
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nicole E Blackburn
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Jason J Wilson
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mathias Skjødt
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Katharina Wirth
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
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Joseph C, Brodin N, Leavy B, Hagströmer M, Löfgren N, Franzén E. Cost-effectiveness of the HiBalance training program for elderly with Parkinson's disease: analysis of data from a randomized controlled trial. Clin Rehabil 2018; 33:222-232. [PMID: 30246557 DOI: 10.1177/0269215518800832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: To determine the cost-effectiveness of the HiBalance training program for managing Parkinson's disease (PD)-related balance and gait disorders. DESIGN: Cost comparison design following the randomized controlled trial comparing a novel balance training intervention with care as usual. SUBJECTS: A total of 100 participants with mild-moderate PD were randomized to either the intervention ( n = 51) or the control group ( n = 49). INTERVENTION: A 10-week (three times per week), group-based, progressive balance training program, led by two physical therapists. MAIN OUTCOMES: All program costs were collected for both groups. Cost-utility was evaluated using quality-adjusted life years (QALYs) and cost-effectiveness measures were the Mini Balance Evaluation Systems Test (Mini-BESTest; assessing balance performance) and gait velocity. Incremental cost-effectiveness ratios were calculated and a probabilistic sensitivity analysis was conducted. RESULTS: The between-group difference in QALYs was 0.043 (95% confidence interval (CI): 0.011-0.075), favoring the intervention group. Between-group differences in balance performance and gait velocity were 2.16 points (95% CI: 1.19-3.13) and 8.2 cm/second (95% CI: 2.9-13.6), respectively, favoring the intervention group. The mean cost per participant in the intervention group was 16,222 SEK (€1649) compared to 2696 SEK (€274) for controls. The estimated incremental cost-effectiveness ratios were 314,558 SEK (€31,969) for an additional QALY, 6262 SEK (€631) for one point improvement in balance performance, and 1650 SEK (€166) for 1 cm/second increase in gait velocity. Sensitivity analyses indicated a high probability (85%) of program success. CONCLUSION: In terms of QALYs, the HiBalance program demonstrated a high probability of cost-effectiveness in the short-term perspective when considering the willingness-to-pay thresholds used in Europe.
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Affiliation(s)
- Conran Joseph
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,2 Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Nina Brodin
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,3 Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden
| | - Breiffni Leavy
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,4 Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Maria Hagströmer
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,5 Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Löfgren
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,5 Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Franzén
- 1 Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,4 Stockholms Sjukhem Foundation, Stockholm, Sweden.,5 Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Huter K, Dubas-Jakóbczyk K, Kocot E, Kissimova-Skarbek K, Rothgang H. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges? Cost Eff Resour Alloc 2018; 16:14. [PMID: 29686540 PMCID: PMC5902889 DOI: 10.1186/s12962-018-0100-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. METHODS Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. RESULTS Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. CONCLUSION There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.
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Affiliation(s)
- Kai Huter
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Katarzyna Dubas-Jakóbczyk
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Kissimova-Skarbek
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Heinz Rothgang
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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28
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Mijnarends DM, Luiking YC, Halfens RJG, Evers SMAA, Lenaerts ELA, Verlaan S, Wallace M, Schols JMGA, Meijers JMM. Muscle, Health and Costs: A Glance at their Relationship. J Nutr Health Aging 2018; 22:766-773. [PMID: 30080217 PMCID: PMC6061527 DOI: 10.1007/s12603-018-1058-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs. DESIGN Cross-sectional Maastricht Sarcopenia Study (MaSS). SETTING Community-dwelling, assisted-living, residential living facility. PARTICIPANTS 227 adults aged 65 and older. MEASUREMENTS Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months. RESULTS Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs). CONCLUSION Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.
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Affiliation(s)
- D M Mijnarends
- Jos Schols, School CAPHRI, Department of Family Medicine, Maastricht University, P.O Box 616, 6200 MD, Maastricht, the Netherlands,
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Roshanravan B, Gamboa J, Wilund K. Exercise and CKD: Skeletal Muscle Dysfunction and Practical Application of Exercise to Prevent and Treat Physical Impairments in CKD. Am J Kidney Dis 2017; 69:837-852. [PMID: 28427790 DOI: 10.1053/j.ajkd.2017.01.051] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/04/2017] [Indexed: 12/25/2022]
Abstract
Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high risk for mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment that includes rehabilitative therapies and counseling on physical activity. Exercise has beneficial effects on systemic inflammation, muscle, and physical performance in chronic kidney disease. Kidney health providers need to identify patient and care delivery barriers to exercise in order to effectively counsel patients on physical activity. A thorough medical evaluation and assessment of baseline function using self-reported and objective function assessment is essential to guide an effective individualized exercise prescription to prevent function decline in persons with kidney disease. This review focuses on the impact of kidney disease on skeletal muscle dysfunction in the context of the disablement process and reviews screening and treatment strategies that kidney health professionals can use in clinical practice to prevent functional decline and disability.
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Affiliation(s)
- Baback Roshanravan
- Division of Nephrology, Department of Medicine, University of Washington Kidney Research Institute, Seattle, WA.
| | - Jorge Gamboa
- Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth Wilund
- Department of Kinesiology and Community Health, University of Illinois, Urbana, IL
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Gill TM, Pahor M, Guralnik JM, McDermott MM, King AC, Buford TW, Strotmeyer ES, Nelson ME, Sink KM, Demons JL, Kashaf SS, Walkup MP, Miller ME. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ 2016; 352:i245. [PMID: 26842425 PMCID: PMC4772786 DOI: 10.1136/bmj.i245] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test whether a long term, structured physical activity program compared with a health education program reduces the risk of serious fall injuries among sedentary older people with functional limitations. DESIGN Multicenter, single blinded randomized trial (Lifestyle Interventions and Independence for Elders (LIFE) study). SETTING Eight centers across the United States, February 2010 to December 2011. PARTICIPANTS 1635 sedentary adults aged 70-89 years with functional limitations, defined as a short physical performance battery score ≤ 9, but who were able to walk 400 m. INTERVENTIONS A permuted block algorithm stratified by field center and sex was used to allocate interventions. Participants were randomized to a structured, moderate intensity physical activity program (n=818) conducted in a center (twice a week) and at home (3-4 times a week) that included aerobic, strength, flexibility, and balance training activities, or to a health education program (n=817) consisting of workshops on topics relevant to older people and upper extremity stretching exercises. MAIN OUTCOME MEASURES Serious fall injuries, defined as a fall that resulted in a clinical, non-vertebral fracture or that led to a hospital admission for another serious injury, was a prespecified secondary outcome in the LIFE Study. Outcomes were assessed every six months for up to 42 months by staff masked to intervention assignment. All participants were included in the analysis. RESULTS Over a median follow-up of 2.6 years, a serious fall injury was experienced by 75 (9.2%) participants in the physical activity group and 84 (10.3%) in the health education group (hazard ratio 0.90, 95% confidence interval 0.66 to 1.23; P=0.52). These results were consistent across several subgroups, including sex. However, in analyses that were not prespecified, sex specific differences were observed for rates of all serious fall injuries (rate ratio 0.54, 95% confidence interval 0.31 to 0.95 in men; 1.07, 0.75 to 1.53 in women; P=0.043 for interaction), fall related fractures (0.47, 0.25 to 0.86 in men; 1.12, 0.77 to 1.64 in women; P=0.017 for interaction), and fall related hospital admissions (0.41, 0.19 to 0.89 in men; 1.10, 0.65 to 1.88 in women; P=0.039 for interaction). CONCLUSIONS In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations. These null results were accompanied by suggestive evidence that the physical activity program may reduce the rate of fall related fractures and hospital admissions in men.Trial registration ClinicalsTrials.gov NCT01072500.
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Affiliation(s)
- Thomas M Gill
- Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT 06510, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mary M McDermott
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Abby C King
- Departments of Health Research & Policy and Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Thomas W Buford
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Miriam E Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kaycee M Sink
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jamehl L Demons
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Susan S Kashaf
- Department of Medicine, Yale School of Medicine, Adler Geriatric Center, 874 Howard Avenue, New Haven, CT 06510, USA
| | - Michael P Walkup
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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