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Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study [with consumer summary]
Bann D, Chen H, Bonell C, Glynn NW, Fielding RA, Manini T, King AC, Pahor M, Mihalko SL, Gill TM, the Life study investigators
Journal of Epidemiology and Community Health 2016 Sep;70(9):930-933
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Evidence is lacking on whether health-benefiting community-based interventions differ in their effectiveness according to socioeconomic characteristics. We evaluated whether the benefit of a structured physical activity intervention on reducing mobility disability in older adults differs by education or income. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicentre, randomised trial that compared a structured physical activity programme with a health education programme on the incidence of mobility disability among at-risk community-living older adults (aged 70 to 89 years; average follow-up of 2.6 years). Education (< high school (0 to 12 years), college (13 to 17 years) or postgraduate) and annual household income were self-reported (< $24,999, $25,000 to $49,999 and > $50,000). The risk of disability (objectively defined as loss of ability to walk 400 m) was compared between the 2 treatment groups using Cox regression, separately by socioeconomic group. Socioeconomic groupxintervention interaction terms were tested. RESULTS: The effect of reducing the incidence of mobility disability was larger for those with postgraduate education (0.72, 0.51 to 1.03; n = 411) compared with lower education (high school or less (0.93, 0.70 to 1.24; n = 536). However, the education group x intervention interaction term was not statistically significant (p = 0.54). Findings were in the same direction yet less pronounced when household income was used as the socioeconomic indicator. CONCLUSIONS: In the largest and longest running trial of physical activity amongst at-risk older adults, intervention effect sizes were largest among those with higher education or income, yet tests of statistical interactions were non-significant, likely due to inadequate power. TRIAL REGISTRATION NUMBER: NCT01072500.
Reproduced with permission from the BMJ Publishing Group.

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