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Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health
WJ Rejeski, PH Brubaker, DC Goff Jr... - Archives of internal ..., 2011 - Am Med Assoc Background Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being. With the growing population of older adults in the United States, effective and scalable public ...
As evident from the 95% CI of the 400MWT data, the magnitude of the treatment difference between WL + PA and SA was substantial. Of course, readers may question the clinical meaningfulness of this difference, given that Kwon et al,28 using data from the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study, proposed that a 20-second change in 400MWT represents the lower end of the range for clinical significance. There are 2 important points to consider. First, LIFE-P29 targeted older adults (>70 years) who had poor mobility. As observed in the current study, change in function is affected dramatically by baseline performance such that those who perform worse at baseline experience greater improvement. Thus, a clinically significant change in 400MWT for more functionally able older adults has yet to be determined but will clearly fall below what Kwon et al28 observed. Second, it is likely that the clinical significance of a change in 400MWT depends on the outcome of interest. Interestingly, the 12-month outcome data for the 400MWT in LIFE-P yielded a change in gait speed of 0.003 m/s for the PA group (from 0.854 m/s to 0.857 m/s), which equates to an improvement of 1.64 seconds, whereas those in the SA group experienced a decline in gait speed of 0.031 m/s (from 0.854 m/s to 0.823 m/s)—17.56 seconds worse. Moreover, the functional changes observed in LIFE-P and power estimates based of failure to complete the 400MWT led to the largest PA trial of older adults ever funded by the National Institute on Aging. Thus, it would be premature to dismiss an 18-second treatment change for the 400MWT in the current study as clinically irrelevant, particularly recognizing that this value was obtained while adhering to the principle of intent-to-treat. Further research on this question is warranted.
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Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health |
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