Multicomponent intervention averts mobility disability in frail older adults

A multicomponent intervention that involves physical activity with technological support and nutritional counseling effectively reduces the incidence of mobility disability in older adults with physical frailty and sarcopenia and short physical performance battery (SPPB) scores of 3‒7, a study has shown.

“Older adults with physical frailty and sarcopenia represent a subset of the older population at risk of adverse health-related events and whose medical needs are currently unmet,” the researchers said. “Therefore, such an intervention may be proposed as a strategy to preserve mobility in older people at risk of disability.”

An evaluator-blinded, randomized controlled trial was conducted at 16 clinical sites across 11 European countries from January 2016 to 31 October 2019. A total of 1,519 community-dwelling adults with physical frailty and sarcopenia (mean age 78.9 years, 1,088 women) were included.

Of the participants, 760 were randomly assigned to a multicomponent intervention, which consisted of moderate-intensity physical activity twice weekly at a centre and up to four times weekly at home, and 759 to education on healthy ageing once a month (controls). Interventions and follow-up lasted for up to 36 months. Mean follow-up was 26.4 months.

Among participants with SPPB score of 3‒7, 283/605 (46.8 percent) in the multicomponent intervention group and 316/600 (52.7 percent) in the control group had mobility disability (hazard ratio [HR], 0.78, 95 percent confidence interval [CI], 0.67‒0.92; p=0.005). Persistent mobility disability occurred in 127/605 (21.0 percent) participants assigned to multicomponent intervention and 150/600 (25.0 percent) controls (HR, 0.79, 95 percent CI, 0.62‒1.01; p=0.06). [BMJ 2022;377:e068788]

The difference in SPPB score between the two groups was 0.8 points (95 percent CI, 0.5‒1.1; p<0.001) and 1.0 point (95 percent CI, 0.5‒1.6; p<0.001) at 24 and 26 months, respectively, in favour of the multicomponent intervention.

Appendicular lean mass

At 24 months, the decline in handgrip strength was smaller in women in the multicomponent intervention group than those in the control group (0.9 kg, 95 percent CI, 0.1‒1.6; p=0.028). Women assigned to the intervention lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 (95 percent CI, 0.10‒0.39; p<0.001) and 36 months (95 percent CI, 0.26‒0.73; p<0.001), respectively.

Serious adverse events occurred in 39.2 percent and 36.0 percent of participants in the multicomponent intervention and control groups, respectively (risk ratio, 1.09, 95 percent CI, 0.94‒1.26). In those with SPPB scores of 8 or 9, mobility disability occurred in 29.7 percent and 23.9 percent in the intervention and control arms, respectively (HR, 1.25, 95 percent CI, 0.79‒1.95; p=0.34).

“The multicomponent intervention showed a positive effect on appendicular lean mass in women, irrespective of SPPB category,” the researchers said.

Earlier studies reported the influence of sex on body composition changes in response to exercise in old age, with women gaining more benefits than men. Sex-specific associations between protein intake and longitudinal changes in appendicular lean mass were also noted in older adults. [Front Med (Lausanne) 2021;8:649748; Eur Rev Aging Phys Act 2021;18:23; Am J Clin Nutr 2020;112:84-95]

“Future studies are warranted to explore whether increasingly available, user friendly, and reliable activity monitoring systems and e-health platforms could enable frail older people to better adhere to physical activity recommendations and be regularly monitored for safety,” the researchers said.