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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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PLOS Medicine


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