Maintaining Mobility Is Key to Living Independently As We Age

Active Approach

Many people worry about not being able to move around as well when they get older. They fear they won’t be able to continue their favorite activities, visit their favorite places, or even keep up with everyday tasks.

Mobility — the ability to move or walk freely and easily — is critical for functioning well and living independently. As we age, we may experience changes to our mobility. There are many reasons for these changes, including changes in gait (how we walk), balance, and physical strength.

All of these can increase the number and severity of falls and make it harder for older adults to go out and visit with friends and family and continue doing their activities independently. Older adults who lose their mobility are less likely to remain living at home; have higher rates of disease, disability, hospitalization, and death; and have poorer quality of life.

“We need to get more older adults exercising. The biggest challenge is being able to motivate people to exercise and then sustain physical activity, especially if they have mobility and functional problems.”

Researchers are working on this issue because it’s not only a matter of physical health, but also impacts the social and emotional well-being of older adults.

Researchers supported by the National Institute on Aging (NAI) are identifying risk factors for physical disability and developing and testing ways to prevent or reverse loss of mobility to help older adults maintain independence. “One of our goals is to continue focusing on research aimed at maintaining independence in mobility in old age,” said Dr. Sergei Romashkan, chief of the NIA’s Division of Geriatrics and Clinical Gerontology Clinical Trials Branch.

Older adults often lose physical function after hospitalization or falls, or if they have movement-related disorders such as Parkinson’s disease. People who have lost physical function may face difficulty with activities of daily living (ADLs), such as eating, bathing, dressing, or using the bathroom without aid. Researchers are investigating ways to improve physical function following hospitalization that would enable older adults to recover and age in place independently at home, avoiding costly institutional care.

A lack of physical activity or exercise can make it more likely that a person will experience loss of mobility as they age. The increasing incidence of sedentarism (sitting too much) is a growing health concern, as too many older adults don’t get enough physical activity and spend too much time sitting daily.

Researchers are studying this issue and working to establish a foundation of scientific evidence on the topic to inform public-health guidelines on how to interrupt sedentary behavior in ways that support healthy aging. In addition, some interventional studies have found positive results of physical activity and exercise on continued mobility.

Clear Results

Many studies have shown that regular exercise improves physical performance. But little is known about whether exercise can actually help prevent major mobility disability, defined as the inability to walk a quarter-mile, or roughly four blocks. Researchers sought to learn more about this connection through the Lifestyle Interventions and Independence for Elders (LIFE) study, which they designed to assess whether a long-term, structured physical activity program was more effective than a health-education program in reducing the risk of major mobility disability in older adults who lived a sedentary lifestyle.

For the study, 1,635 participants aged 70 to 89 were randomly assigned to a structured, moderate-intensity physical-activity program, or to a health-education program of workshops on topics relevant to older adults. Racially and ethnically diverse participants at high risk for disability were recruited from eight university centers across the U.S. in urban, suburban, and rural communities. They had some evidence of impaired function at baseline but were all able to walk 400 meters (about a quarter-mile) in a screening test. The objective of the intervention was to maintain this ability and prevent loss of ability to walk this distance.

The physical-activity intervention involved walking (with a goal of 150 minutes a week), strength training (including the use of ankle weights), flexibility, and balance training, and included attending instructor-led exercise classes twice a week at a center and a home-based activity three to four times per week for two years. The health-education program included weekly health education workshops on topics such as travel safety, health screenings, and nutrition, along with five to 10 minutes of instructor-led upper-body stretching and flexibility exercises for the first 26 weeks, and then monthly sessions for the remainder of the study. Participants were assessed every six months at clinic visits for physical-activity measures, including the ability to walk 400 meters.

Results showed that, over 2.6 years, the physical-activity program reduced the risk of major mobility disability by 18% compared with the health-education program. These findings suggest that older adults who are vulnerable to disability can benefit from physical activity.

“The intervention was not only effective in preventing mobility disability, but it was also cost-effective,” said Dr. Marco Pahor, principal investigator of the LIFE study, director of the Institute on Aging at the University of Florida in Gainesville, and chair of Aging and Geriatric Research at the university’s College of Medicine.

“Those who started with the poorest function benefited the most from the physical-activity program. The results also showed perceived benefits in walking speed and physical performance scores,” he added, meaning people felt they were getting benefits beyond what the study could actually measure.

This groundbreaking study was the largest and longest-lasting randomized, controlled trial ever conducted on physical activity in older adults. Its findings have shaped several U.S. and international recommendations for physical activity in older adults.

“Beyond the specific findings on exercise, the study showed that older adults, who are traditionally excluded from large clinical trials, can be successfully recruited and retained for clinical studies, and will adhere to an exercise program,” said Dr. Jack Guralnik, co-principal investigator for the study and a professor in the Department of Epidemiology and Public Health, Division of Gerontology, at the University of Maryland School of Medicine in Baltimore. Guralnik was formerly chief of the NIA’s Laboratory of Epidemiology, Demography, and Biometry.

“We’ve come a long way in the last 20 to 25 years, but a lot more can be done,” he added. “We need to get more older adults exercising. The biggest challenge is being able to motivate people to exercise and then sustain physical activity, especially if they have mobility and functional problems.”

Taking a Stand Against Sitting

Many older adults struggle to engage in health-enhancing physical activity and spend, on average, between nine and 13 hours a day sitting.

There is little scientific evidence on how best to interrupt long periods of sedentary behavior, and few studies that have focused on physical-activity interventions to reduce such behavior. Still, interventions focused on standing have been shown to reduce sedentary behavior up to two hours per day. Also, epidemiological studies have shown associations between self-reported sedentary behavior and increased risks of death and metabolic outcomes, but very few prospective studies have used objective measures of sedentary behavior.

In the future, research on maintaining independence in older adults might include more practical studies to evaluate strategies for implementation in real-world settings and interdisciplinary studies on mobility that integrate expertise in muscle physiology and neurology, according to Romashkan. It might also include developing more meaningful quality-of-life measures and intervention studies to determine how specific mechanisms of physical activity enhance mobility function in older adults, which could lead to improved exercise interventions or alternative treatments, he added.

And, with increased mobility, older adults can move around and perform daily activities more easily and safely, while continuing to live as independently as possible.

This article first appeared on the website of the National Insitute on Aging, a division of the National Institutes of Health.