Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: The REACT (REtirement in ACTion) randomised controlled trial

Afroditi Stathi, Colin Greaves, Janice L Thompson, Janet Withall, Peter Ladlow, Gordon Taylor, Antonieta Medina-Lara, Tristan Snowsill, Selena Gray, Colin Green, Heidi Johansen-Berg, Claire E. Sexton, James Bilzon, Jolanthe De Koning, Jessica C. Bollen, Sarah Moorlock, Max Western, Naiara Demnitz, Poppy Seager, Jack Guralnik Jack Rejeski, Melvyn Hillsdon, Kenneth R Fox

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)

Abstract

Background
Mobility limitations in older age greatly reduce quality of life, generate substantial health and social care costs and increase mortality. The Retirement in Action (REACT) trial aimed to establish whether a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Methods
We recruited older adults with reduced lower limb physical functioning (65 years and older; Short Physical Performance Battery (SPPB) score 4-9) into a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT). Recruitment was largely via 35 primary care practices in urban and semi-rural locations across three sites in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity and behavioural maintenance programme delivered by charity and community /leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance age, gender and SPPB score, using a centralised online randomisation algorithm. Data collection and analyses were blinded. The primary outcome was change in lower limb physical function (SPPB score) at 24 months analysed by intention-to-treat. Trial registration number is ISRCTN45627165.
Findings
Between June 2016 and October 2017, 777 participants (mean age 77.6, SD 6.8; 66% female; mean SPPB score 7.37, SD 1.56) were randomised to the intervention (410) and control (367) arms. Primary outcome data at 24 months were provided by 628 (81%) participants. At 24-month follow-up, SPPB score was significantly greater in the intervention arm (mean 8.08, SD 2.87) compared with controls (mean 7.59, SD 2.61), with an adjusted mean difference of 0.49 (95%CI: 0.06 to 0.92).The difference in lower limb function between intervention and control participants was clinically meaningful at 6, 12 and 24 months. One adverse event was related to the intervention.
Interpretation
For older adults at risk of mobility limitations, the REACT intervention prevented decline in physical function over a 24-month period.

Funding: National Institute for Health Research Public Health Research Programme (13/164/ 51).

Trial Registration: ISRCTN45627165
Original languageEnglish
Pages (from-to)E316-E326
JournalThe Lancet Public Health
Volume7
Issue number4
Early online date21 Mar 2022
DOIs
Publication statusPublished - 30 Apr 2022

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