Effect of a Nutrition Supplement and Physical Activity Program on Pneumonia and Walking Capacity in Chilean Older People: A Factorial Cluster Randomized Trial
Background:
Ageing is associated with increased risk of poor health and functional
decline. Uncertainties about the health-related benefits of nutrition and
physical activity for older people have precluded their widespread
implementation. We investigated the effectiveness and cost-effectiveness of
a national nutritional supplementation program and/or a physical activity
intervention among older people in Chile.
Methods and Findings:
We conducted a cluster randomized factorial trial among low to middle
socioeconomic status adults aged 65–67.9 years living in Santiago,
Chile. We randomized 28 clusters (health centers) into the study and
recruited 2,799 individuals in 2005 (∼100 per cluster). The
interventions were a daily micronutrient-rich nutritional supplement, or two
1-hour physical activity classes per week, or both interventions, or
neither, for 24 months. The primary outcomes, assessed blind to allocation,
were incidence of pneumonia over 24 months, and physical function assessed
by walking capacity 24 months after enrolment. Adherence was good for the
nutritional supplement (∼75%), and moderate for the physical
activity intervention (∼43%). Over 24 months the incidence rate
of pneumonia did not differ between intervention and control clusters (32.5
versus 32.6 per 1,000 person years respectively; risk
ratio = 1.00; 95% confidence interval
0.61–1.63; p = 0.99). In
intention-to-treat analysis, after 24 months there was a significant
difference in walking capacity between the intervention and control clusters
(mean difference 33.8 meters; 95% confidence interval
13.9–53.8; p = 0.001). The
overall cost of the physical activity intervention over 24 months was
US$164/participant; equivalent to US$4.84/extra meter walked.
The number of falls and fractures was balanced across physical activity
intervention arms and no serious adverse events were reported for either
intervention.
Conclusions:
Chile's nutritional supplementation program for older people is not
effective in reducing the incidence of pneumonia. This trial suggests that
the provision of locally accessible physical activity classes in a
transition economy population can be a cost-effective means of enhancing
physical function in later life.
Trial registration:
Current Controlled Trials ISRCTN 48153354
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Effect of a Nutrition Supplement and Physical Activity Program on Pneumonia and Walking Capacity in Chilean Older People: A Factorial Cluster Randomized Trial. PLoS Med 8(4): e32767. doi:10.1371/journal.pmed.1001023
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001023
Souhrn
Background:
Ageing is associated with increased risk of poor health and functional
decline. Uncertainties about the health-related benefits of nutrition and
physical activity for older people have precluded their widespread
implementation. We investigated the effectiveness and cost-effectiveness of
a national nutritional supplementation program and/or a physical activity
intervention among older people in Chile.
Methods and Findings:
We conducted a cluster randomized factorial trial among low to middle
socioeconomic status adults aged 65–67.9 years living in Santiago,
Chile. We randomized 28 clusters (health centers) into the study and
recruited 2,799 individuals in 2005 (∼100 per cluster). The
interventions were a daily micronutrient-rich nutritional supplement, or two
1-hour physical activity classes per week, or both interventions, or
neither, for 24 months. The primary outcomes, assessed blind to allocation,
were incidence of pneumonia over 24 months, and physical function assessed
by walking capacity 24 months after enrolment. Adherence was good for the
nutritional supplement (∼75%), and moderate for the physical
activity intervention (∼43%). Over 24 months the incidence rate
of pneumonia did not differ between intervention and control clusters (32.5
versus 32.6 per 1,000 person years respectively; risk
ratio = 1.00; 95% confidence interval
0.61–1.63; p = 0.99). In
intention-to-treat analysis, after 24 months there was a significant
difference in walking capacity between the intervention and control clusters
(mean difference 33.8 meters; 95% confidence interval
13.9–53.8; p = 0.001). The
overall cost of the physical activity intervention over 24 months was
US$164/participant; equivalent to US$4.84/extra meter walked.
The number of falls and fractures was balanced across physical activity
intervention arms and no serious adverse events were reported for either
intervention.
Conclusions:
Chile's nutritional supplementation program for older people is not
effective in reducing the incidence of pneumonia. This trial suggests that
the provision of locally accessible physical activity classes in a
transition economy population can be a cost-effective means of enhancing
physical function in later life.
Trial registration:
Current Controlled Trials ISRCTN 48153354
: Please see later in the article for the Editors' Summary
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