Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health

Abstract

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 health approaches are needed to address this problem. Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health.

Methods: The study design was a translational, randomized controlled trial of physical activity (PA) and weight loss (WL) on mobility in overweight or obese older adults with cardiovascular disease (CVD) or at risk for CVD. The study was conducted within the community infrastructure of Cooperative Extension Centers. Participants were randomized to 1 of 3 interventions: PA, WL + PA, or a successful aging (SA) education control arm. The primary outcome was time to complete a 400-m walk in seconds (400MWT).

Results: A significant treatment effect (P = .002) and follow-up testing revealed that the WL + PA group improved their 400MWT (adjusted mean [SE], 323.3 [3.7] seconds) compared with both PA (336.3 [3.9] seconds; P = .02) and SA (341.3 [3.9] seconds; P < .001). Participants with poorer mobility at baseline benefited the most (P < .001).

Conclusion: Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility.

Trial registration: clinicaltrials.gov Identifier: NCT00119795.

Figure 1

Consolidated Standards of Reporting Trials (CONSORT) diagram (for “Did not complete 400-m walk,” the participants had dropped out, died, missed follow-up or contact with them was lost [“missed/lost contact”], or they were unable to attend the screening visit or could not be located).

Figure 2

Adjusted means of the change from baseline in 400-m walk time and 95% confidence intervals by treatment condition (SA, successful aging; PA, physical activity; and WL+PA, weight loss+physical activity).