Frailty, Fitness, and Quality of Life Outcomes of a Healthy and Productive Aging Program (GrandMove) for Older Adults With Frailty or Prefrailty: Cluster Randomized Controlled Trial
Background: Exercise interventions can reverse frailty. However, their scalability and sustainability are limited by manpower, which is shrinking with population aging. GrandMove is a program that combines healthy and productive aging strategies to (1) train and employ robust older adults as exercise coaches; and (2) improve fitness and motivate adoption of exercise habit in frail and prefrail older adults. Objective: The study examined the effectiveness of GrandMove in improving frailty, fitness, and quality of life in frail and prefrail older adults. Methods: This cluster randomized controlled trial recruit frail and prefrail older adults (N=390) living in the community. The 18-month exercise program consisted of three 6-month phases of lifestyle education (E), resistance exercise (R), and aerobic exercise (A). Each group of participants was randomized into three intervention sequence arms: Group E-R-A, Group A-R-E, and Group R-A-E. Results: At 6, 12, and 18 months, 346, 305, and 264 participants completed frailty assessment, respectively. At 6-month, 100 out of 346 participants (28.9%) became robust. Group A-R-E and Group R-A-E were no better than Group E-R-A as the active control in addressing frailty over the first 6 months (Group A-R-E: interaction coefficient 0.07 [95% CI -0.35 to 0.49]; Group R-A-E: interaction coefficient -0.02 [95% CI -0.42 to 0.38]; both P > .01). Compared to lifestyle education, resistance training and aerobic training over the first 6 months were associated with greater improvement in fitness measures of grip strength in left hand (Group A-R-E: interaction coefficient 2.99 [95% CI 0.76 to 5.23]; P = .009. Group R-A-E: interaction coefficient 2.21 [95% CI 0.63 to 4.36]; P = .044) and right hand (Group A-R-E: interaction coefficient 3.75 [95% CI 1.54 to 5.97]; P = .001. Group R-A-E: interaction coefficient 2.29 [95% CI 0.16 to 4.42]; P = .035) and arm curl test (Group A-R-E: interaction coefficient 1.42 [95% CI 0.39 to 2.46]; P = .007. Group R-A-E: interaction coefficient 1.11 [95% CI 0.12 to 2.11]; P = .029). The sequence of exercise interventions (Group R-A-E vs Group A-R-E) did not make a difference in primary outcomes at 12 months, but the R-A-E group showed better quality of life (interaction coefficient 4.50 [95% CI 0.12 to 8.88] P = .008). Improved frailty outcome was maintained by the end of the study, but change in overall physical activity level was limited. Conclusions: Combining healthy and productive aging strategies is a scalable and sustainable way to improve frailty, fitness, and quality of life in frail and prefrail older adults. Different combinations of lifestyle education and physical interventions improved frailty. Clinical Trial: HKU Clinical Trials Registry HKUCTR-1964; https://www.hkuctr.com/Study/Show/75c5d2e6825c4b5498f0c65c82714c4b
