Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial
Open accessAbstract
IMPORTANCE: In older adults reduced mobility is common and is an independent risk factor for morbidity, hospitalization, disability, and mortality. Limited evidence suggests that physical activity may help prevent mobility disability; however, there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability. OBJECTIVE: To test the hypothesis that a long-term structured physical activity program is more effective than a health education program (also referred to as a successful aging program) in reducing the risk of major mobility disability. DESIGN, SETTING, AND PARTICIPANTS: The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, randomized trial that enrolled participants between February 2010 and December 2011, who participated for an average of 2.6 years. Follow-up ended in December 2013. Outcome assessors were blinded to the intervention assignment. Participants were recruited from urban, suburban, and rural communities at 8 centers throughout the United States. We randomized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations, defined as a score on the Short Physical Performance Battery of 9 or below, but were able to walk 400 m. INTERVENTIONS: Participants were randomized to a structured, moderate-intensity physical activity program (n = 818) conducted in a center (twice/wk) and at home (3-4 times/wk) that included aerobic, resistance, and flexibility training activities or to a health education program (n = 817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. MAIN OUTCOMES AND MEASURES: The primary outcome was major mobility disability objectively defined by loss of ability to walk 400 m. RESULTS: Incident major mobility disability occurred in 30.1% (246 participants) of the physical activity group and 35.5% (290 participants) of the health education group (hazard ratio [HR], 0.82 [95% CI, 0.69-0.98], P = .03).Persistent mobility disability was experienced by 120 participants (14.7%) in the physical activity group and 162 participants (19.8%) in the health education group (HR, 0.72 [95% CI, 0.57-0.91]; P = .006). Serious adverse events were reported by 404 participants (49.4%) in the physical activity group and 373 participants (45.7%) in the health education group (risk ratio, 1.08 [95% CI, 0.98-1.20]). CONCLUSIONS AND RELEVANCE: A structured, moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability. These findings suggest mobility benefit from such a program in vulnerable older adults. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01072500.
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The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.
“The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty (76,77).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [76]
The Results, under “Major mobility disability” (page not available), report fewer cases in the physical-activity group than in the health-education group. The Results also report increased moderate activity, but do not establish reduced sedentary time; the paper does not report a reduction in frailty. Participants were sedentary older adults with physical limitations, not a group identified in the paper as frail. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe benefits of a structured exercise program (as in the LIFE study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.
“The benefits of a structured exercise program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty (84).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [84]
The Results section (Major mobility disability; page not provided) reports fewer cases in the physical-activity group than in the health-education group (30.1% versus 35.5%). The Results section (Intervention adherence; page not provided) reports more moderate activity, but does not establish reduced sedentary time; the copy also does not report reduced frailty. Participants were sedentary older adults with physical limitations, not specifically identified as frail. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe benefits of a structured physical activity program in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty.
“The benefits of a structured physical activity program (as in the Lifestyle Interventions and Independence for Elders [LIFE] study) in frail older adults include reducing sedentary time, preventing mobility disability, and reducing frailty”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [95]
The Results (Major mobility disability; page unavailable) show that the structured physical activity group had less major mobility disability than the health education group. Results (Intervention adherence; page unavailable) show more moderate activity, but do not establish reduced sedentary time; the paper also does not report a reduction in frailty. Participants were sedentary older adults with physical limitations, not explicitly identified as frail. (LLM, conf=0.89)
Experimental — accuracy not yet measuredThe LIFE study demonstrated reduced persistent mobility disability (HR 0.72, 95% CI 0.57-0.91) compared with a health education programme.
“demonstrated reduced persistent mobility disability (HR 0.72, 95% CI 0.57–0.91) compared with a health education programme”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [282]
The LIFE study is considered a standard for physical activity in older adults, but it lacks evidence in sarcopenic obesity and the pilot trial lacked power.
“Although the LIFE study is considered a standard for physical activity in older adults282, we acknowledge its lack of evidence in sarcopenic obesity and the lack of power in this pilot trial.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [282]
The LIFE multicenter randomized clinical trial in 1635 older persons at risk of disability showed a significant reduction in the risk of major mobility disability after an average of 2.6 years of follow-up in those randomized to physical activity compared to a health education program.
“The Lifestyle Interventions and Independence for Elders (LIFE) multicenter randomized clinical trial in 1635 older persons at risk of disability showed a significant reduction in the risk of major mobility disability after an average of 2.6 years of follow-up in those randomized to PA compared to a health education program [507].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [507]
The LIFE multicenter randomized clinical trial in 1635 older persons at risk of disability showed a significant reduction in major mobility disability after an average of 2.6 years in those randomized to physical activity compared to health education.
“The Lifestyle Interventions and Independence for Elders (LIFE) multicenter randomized clinical trial in 1635 older persons at risk of disability showed a significant reduction in the risk of major mobility disability after an average of 2.6 years of follow-up in those randomized to PA compared to a health education program [507].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [507]
A lifestyle intervention study of aerobic and resistance exercise versus health education in older people aged 70-89 years resulted in a positive improvement in physical activity (SPPB) over an average of 2.7 years follow-up.
“A lifestyle intervention study of aerobic and resistance exercise versus health education in older people (aged 70-89 years) resulted in a positive improvement in physical activity (SPPB) over an average of 2.7 years follow-up [79].”
From Is There Enough Evidence for Osteosarcopenic Obesity as a Distinct Entity? A Critical Literature Review (2019) · cites this paper as [79]
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References 31 · Cited by 1,427
- Authors
- Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., King, A. C., Kritchevsky, S. B., Manini, T. M., McDermott, M. M., Miller, M. E., Newman, A. B., Rejeski, W. J., Sink, K. M., & Williamson, J. D.
- Affiliations
- University of Florida (US)
- University of Maryland, Baltimore (US)
- Wake Forest University Health Sciences (US)
- University of South Carolina (US)
- National Heart, Lung, and Blood Institute (US)
- Pennington Biomedical Research Center (US)
- Tufts University (US)
- Yale University (US)
- University of California San Diego (US)
- Stanford Medicine (US)
- Northwestern University (US)
- University of Pittsburgh (US)
- Corresponding author
- Pahor, Marco
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-06-18
- Volume
- 311
- Issue
- 23
- Pages
- 2387
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4266388
- OpenAlex
- W2160684941
- Cited by
- 1,427
- References
- 31
- Citations by year
- 2026: 88 · 2025: 94 · 2024: 118 · 2023: 105 · 2022: 139 · 2021: 127 · 2020: 134 · 2019: 124 · 2018: 127 · 2017: 120 · 2016: 138 · 2015: 89 · 2014: 22 · 2013: 1 · 2012: 1
- FWCI
- 318.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001085, UL1TR000064, UL1TR000142, 5p30ag031679-15)
- National Institute on Aging (1-P30-AG21332, U01AG022376, 1 P30 AG031679, 3U01AG022376-05A2S, UO1 AG22376, P30-AG031679, K07AG3587, P30AG024827, P30AG028740, P30AG021332, P30AG021342)
- National Heart, Lung, and Blood Institute (R01HL121023)
- National Center for Research Resources (UL1RR029890, UL1RR025744, U54RR025208)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD065688)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- mobility impairment, older adults, physical activity interventions, health education, successful aging, life studies, sedentary older adults, physical limitations, home-based exercise, resistance training, aerobic exercise, flexibility training, adverse events, frailty, falls, fall-related injuries, hospitalization, quality of life
- MeSH terms
- Aged, Aged, 80 and over, Exercise Therapy, Female, Persons with Disabilities, Disabled Persons, Health Education, Humans, Life Style, Male, Risk, Exercise, Single-Blind Method, Walking, Motor Skills Disorders, Sedentary Behavior
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