Study shows effectiveness of community group exercise program for older adults with limited mobility

Results of a major study of the effectiveness of a community-based group exercise program designed for people aged 65 and over with limited mobility show that REACT prevents physical decline and is cost-effective to perform. The team behind says it should be rolled out nationwide.

A decline in mobility associated with aging can significantly reduce quality of life, lead to a loss of autonomy, generate significant health and social protection costs and reduce overall life expectancy. The pressure on health systems is expected to be exacerbated by the rapidly expanding elderly population. Currently, three in 10 people of legal retirement age are classified as disabled due to mobility limitations.

REACT – otherwise known as RETIREMENT IN ACTION program – is an innovative behavior change intervention specifically targeting older people who are beginning to experience mobility limitations (for example, those who are beginning to find it more difficult to get upstairs, walk to the store, or walk to getting up from a chair). It aims to prevent further decline in mobility through exercises that target lower extremity strength, balance and endurance.

The program emphasizes fun, social interaction and building community through group sessions while providing accessible strength, balance, mobility and cardiovascular exercises tailored to individual needs. of each participant.

Based on the results of a large randomized controlled trial, the international research team from the Universities of Bath, Birmingham, Exeter and the University of the West of England (UWE) (UK) and University of Maryland School of Medicine and Wake Forest (USA) say REACT can help older people avoid a downward spiral of declining mobility, which can accelerate and lead to social isolation and the loss of independence.

Funded by the National Institute for Health Research (NIHR) Public Health Research Program, REACT was run at three sites (Bath/Bristol, Birmingham and Devon) for four and a half years. It involved 777 participants aged 65 and over (the oldest participant was 98). Participants were divided into an intervention group or a control group.

Members of the intervention group participated in REACT twice a week for three months, then once a week for an additional nine months. Members of the control group took three separate “healthy aging” courses during the year. By comparing the two groups, the researchers were able to test the effectiveness of REACT on lower extremity mobility, as well as health and social care utilization.

Their results, published today [Monday 21 March 2022 – 23.30] in two articles of Lancet Public Health, CA shows:

• At 24 months (12 months after completion of the REACT intervention), participants who attended the sessions had significantly greater mobility than those who did not, suggesting a positive short- and long-term effect.
• This meant that REACT participants found it easier to walk, climb stairs, and had greater independence in carrying out their daily activities.
• At least one session of strength, balance and mobility exercises per week (a fairly low level of engagement) was sufficient to provide significant benefits on lower extremity physical function.
• Per person, the cost of delivering the program was £622, but the healthcare savings were £725 over two years. The longer term savings could be much higher.

Physical activity has a wide range of benefits for older adults, including longer and healthier lives, extended independence and autonomy, improved mobility and improved well-being. Yet many older people face a downward spiral of declining mobility, in which the less active they are, the more limited they become..”

Afroditi Stathi, University of Birmingham REACT Professor and Lead Researcher

“Thanks to REACT, we have shown that this steady decline is preventable. It can be prevented or, in many cases, reversed with a personalized and progressive exercise program.

“At least one session of REACT exercise per week appears to be sufficient to provide clinically significant benefits on lower extremity physical function and is highly cost-effective. This is a strong public health message to convey to older adults, both in the UK and around the world.”

Bath-based REACT participant Mr Fayek Osman, 74, said: “The program has improved my well-being as my ability to walk and climb stairs improves. REACT has been of great help to me and has encouraged me to pursue advanced level activities. It also reinforces my belief that some exercise is better than none at all.”

Dr Tristan Snowsill from the University of Exeter, who reviewed the economic data from the study with Professor Antonieta Medina-Lara, said: “We found clear evidence that quality of life was improved in the REACT group. That alone would probably have been enough. to justify the cost of the program using the standard profitability rule. Also finding that REACT participants used fewer health and care services makes the REACT program one of the clearest cases of value for money I have encountered.

The team now hopes that REACT can be rolled out nationwide through community activity providers based in local areas.

Dr Max Western from the University of Bath Department of Health explained: “REACT has always been about having real impacts on people’s lives. Given these significant findings, we call on healthcare professionals and policy makers to build on our findings and implement similar REACT sessions. in other parts of the country. Our studies show how effective REACT can be; we hope that many more people will soon be able to benefit from it as our participants have done. »

Dr Janet Withall, from the University of Birmingham, is the REACT trial leader. She added, “We would like to thank all 777 REACT participants who gave of their time and enthusiasm, and without whom the study would not have been possible. Nor would we have been able to conduct the study. REACT without all of our delivery partners who have supported us with their time, resources and expertise.”