Integrating a Prevention Care Path into the Daily Life of Older Adults with Mobility Disability Risk: Introducing a Predictive Response Model to Exercise

Abstract

Introduction

Exercise and nutrition are the best targets to tackle mobility issues in community-dwelling older adults. As exercise response relies on multiple factors, improving the understanding of their interactions is a necessity to tailor effective preventive strategies. Based on a prevention care path designed for community-dwelling older adults with mobility disability risk, our main goal was to determine the predictive factors of the response to a multimodal intervention, combining structured exercise training and nutritional counselling. Thus, this study aimed to tailor prevention programs for non-responder participants.

Methods

We analyzed the response of participants to a prevention program and built a multivariate predictive model to highlight the profile of the best responders. The model was based on the likelihood of at least 1 point of short physical performance battery (SPPB) score gain. Inclusion criteria were being aged ≥70 years and having completed a multicomponent group-based supervised training consisting of 20 sessions (10 weeks).

Results

A total of 103 participants were included, their mean ± SD age was 81.9 ± 5.7 years. The model demonstrated interactions between baseline SPPB score (OR=0.42; p < 0.001), body mass index (BMI; OR=0.82; p=0.003), and grip strength value (OR=1.15; p=0.008). The highest probability of response was found for participants with low SPPB, normal BMI (21 kg/m²), and high grip strength (27 kg).

Conclusion

This study demonstrated that the response to a multimodal intervention in community-dwelling older adults with mobility disability risk was influenced by the baseline SPPB score, BMI, and grip strength value. To increase the proportion of responders, strategies that could be more effective include constituting more homogenous group, and implementing a specific approach for obese sarcopenic older adults and those with low grip strength by increasing the dose of physical activity and monitoring endurance and mobility activities between sessions. Our results provide important consideration for the development of targeted-interventions.

Keywords:

• exercise
• nutrition
• prevention
• responders profiles

Acknowledgments

The authors acknowledge geriatricians, dieticians, medical secretaries and clinical research assistants from Hôpital Lyon Sud, Hospices Civils de Lyon, for their involvement in the program, their participation in assessments and their help to collect data. Authors acknowledge municipalities of Métropole de Lyon for their collaboration to propose the care path. Authors acknowledge financial partners such as the Agence Régionale de la Santé (Auvergne Rhône Alpes), Conférence des Financeurs de la métropole de Lyon et du Rhône, and the Mutuelle des Travailleurs de la Région Lyonnaise (MTRL) for their support and their confidence. Also, authors acknowledge the Caisse d’Assurance Retraite et la Santé au Travail (CARSAT) for their implication as the main relay for participants. The authors thank Hélène Boyer (Hospices Civils de Lyon) for help in manuscript preparation.

Disclosure

The authors report no conflicts of interest related to this work.