University of Birmingham: Tailored group exercise benefits over-65s with mobility limitations

A landmark study has demonstrated long-term positive impacts and cost effectiveness of tailored group exercise for over-65s with mobility limitations.

The study examined the effectiveness of a community-based group exercise programme designed for people aged 65 and over with mobility limitations. It showed that REACT prevents physical decline and is cost-effective to run. The team behind it say it should be rolled out nationwide.

A decline in mobility associated with ageing can greatly reduce quality of life, lead to loss of independence, generate substantial health and social care costs, and reduce overall life expectancy. Pressure on healthcare systems is set to be exacerbated by the rapid expansion of the older population. Currently, three in 10 people of state pension age are classified as disabled due to mobility limitations.

REACT – otherwise known as the REtirement in ACTion programme – is an innovative, behaviour change intervention targeted specifically at older adults who are beginning to experience mobility limitations (e.g., those who are beginning to find climbing upstairs, walking to the shop, or getting up from a chair more of a challenge). It aims to prevent further decline in mobility through exercises that target lower limb strength, balance, and stamina.

The programme focuses on fun, social interaction and building a community through the group-based sessions whilst providing accessible strength, balance, mobility, and cardio-vascular exercises tailored to each participant’s needs.

Play videoMembers of the REACT Study taking part in exercise
Professor Afroditi Stathi and Dr Janet Withall explain the REACT Study
Based on results from a large, randomised control trial, the international research team from the universities of Bath, Birmingham, Exeter, and the University of the West of England (UWE) (UK) and the University of Maryland School of Medicine and Wake Forest (US) say that REACT can help older people avoid a downward spiral of declining mobility, which can accelerate and lead to social isolation and loss of independence.

Funded by the National Institute for Health Research (NIHR) – Public Health Research programme, REACT ran across three sites (Bath / Bristol, Birmingham, and Devon) over four and a half years. It involved 777 participants aged 65 and over (the oldest participant was 98). Participants were split into either an intervention or a control group.

Those in the intervention group attended REACT twice a week for three months and then once a week for a further nine months. Those in the control group attended three separate ‘healthy ageing’ classes over the course of the year. By comparing the two groups, researchers were able to test the effectiveness of REACT on lower limb mobility, as well as looking at health and social care usage.

Their results, which are published today [Monday 21 March 2022] in two papers in the Lancet Public Health, show that:
At 24-months (12 months after the completion of the REACT intervention), the participants who had attended sessions had significantly greater mobility than those who did not, suggesting both a short and long-term positive effect.
This meant REACT participants found it easier walking, climbing stairs, and had greater independence performing daily activities.
At least one exercise session per week, consisting of strengthening, balance and mobility-based activities (a fairly low level of commitment) was sufficient to provide meaningful benefits on lower limb physical function
Per person, the cost of delivering the programme was £622, but the health care savings were £725 over two years. Longer-term savings could be far higher.
Physical activity carries a wide range of benefits for older people including a longer and healthier life, prolonged independence and autonomy, better mobility and improved wellbeing. Yet, many older people face a downward spiral of declining mobility, whereby the less active they are, the more limited they become. Through REACT we have shown that this steady decline is avoidable. It can be prevented, or in many cases be reversed through an exercise programme that is individually tailored and progressive. At least one REACT exercise session per week seems sufficient to provide clinically meaningful benefits on lower limb physical function and it is highly cost-effective. This is a strong public health message to give to older adults, both in the UK and around the world.
Professor Afroditi Stathi, REACT Chief Investigator from the University of Birmingham
Bath-based REACT participant, Mr Fayek Osman, aged 74, said: “The programme improved my wellbeing as my walking ability and stair climbing are improving. REACT has been of great benefit to me and encouraged me to continue with advanced level of activities. It also strengthens my belief that some exercise is better than nothing at all.”

Dr Tristan Snowsill of the University of Exeter, who examined the economic data from the study with Professor Antonieta Medina-Lara, said: “We found clear evidence that quality of life was improved in the REACT group. This alone would most likely have been enough to justify the cost of the programme using the standard rule for cost-effectiveness. To also find that REACT participants used fewer health and care services makes the REACT programme one of the clearest cases of value for money I have come across.”

Professor Janice Thompson from the University of Birmingham who helped design and deliver the study added: “REACT benefitted older adults across different geographic regions in England, suggesting that the intervention’s benefits are not specific to one community or area. Our findings show that important benefits can be gained and sustained by relatively modest engagement in physical and social activities.”

Professor Colin Greaves, the site lead for University of Exeter (and now Professor of Psychology Applied to Health at University of Birmingham) added: “We were particularly pleased to see that effects of the REACT programme were maintained for 24 months. This reflects the design of the programme, which included evidence-based behaviour change techniques to promote maintenance of both the exercises learned during REACT and wider engagement in physical activity as part of their day-to-day lifestyle.”

“Keeping the programme going after 12 months may lead to even stronger longer-term effects and cost savings and that could be a good direction for future research.”

Dr Janet Withall, the REACT Trial Manager added: “We would like to thank all 777 REACT participants who contributed their time and enthusiasm, and without whom the study would not have been possible. We also could not have conducted the REACT study without all our delivery partners who supported us with their time, resources and expertise.”

REACT delivery partners included: Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John’s Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; the Portway Lifestyle Centre and Solihull Borough Council, Birmingham.