Abstract
Background
Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation.
Methods
In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4–9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165.
Findings
Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06–0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls.
Interpretation
For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period.
Funding
National Institute for Health Research Public Health Research Programme (13/164/51).
Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation.
Methods
In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4–9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165.
Findings
Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06–0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls.
Interpretation
For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period.
Funding
National Institute for Health Research Public Health Research Programme (13/164/51).
| Original language | English |
|---|---|
| Journal | The Lancet. Public health |
| Early online date | 21 Mar 2022 |
| DOIs | |
| Publication status | E-pub ahead of print - 21 Mar 2022 |
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Fingerprint
Dive into the research topics of 'Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (REtirement in ACTion) randomised controlled trial'. Together they form a unique fingerprint.Research output
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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
Snowsill, T., Stathi, A., Green, C., Withall, J., Greaves, C., Thompson, J., Taylor, G., Gray, S., Johansen-Berg, H., Bilzon, J., De Koning, J., Boles, J., Moorlock, S., Western, M. J., Guralnik, J. M., Rejeski, W. J., Fox, K. R. & Medina-Lara, A., Apr 2022, In: The Lancet Public Health. 7, 4, p. e327-e334Research output: Contribution to journal › Article › peer-review
Open AccessFile127 Downloads (Pure) -
The tribulations of trials: lessons learnt recruiting 777 older adults into REtirement in ACTion (REACT) a community, group-based active ageing intervention targeting mobility disability.
REACT Study Research Group, Withall, J., Greaves, C., Thompson, J., De Koning, J., Bollen, J., Moorlock, S., Fox, K. R., Western, M., Snowsill, T., Medina-Lara, A., Cross, R., Ladlow, P., Taylor, G., Zisi, V., Clynes, J., Gray, S., Agyapong-Badu, S., Guralnik, J. M. & Rejeski, W. J. & 1 others, , 9 Mar 2020, In: The journals of gerontology. Series A, Biological sciences and medical sciences. 75, 12, p. 2387-2395 9 p.Research output: Contribution to journal › Article › peer-review
Open AccessFile336 Downloads (Pure) -
A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion [REACT]): study protocol for a randomised controlled trial
Stathi, A., Withall, J., Greaves, C., Thompson, J., Taylor, G., Medina-Lara, A., Green, C., Bilzon, J., Gray, S., Johansen-Berg, H., Sexton, C., Western, M., De Koning, J., Bollen, J., Moorlock, S., Demnitz, N., Seager, P., Guralnik, J. M., Rejeski, W. J. & Fox, K. R., 17 Apr 2018, In: Trials. 19, 228.Research output: Contribution to journal › Article › peer-review
Open AccessFile6 Citations (Scopus)249 Downloads (Pure)
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