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J Am Geriatr Soc. 2019 Dec 22. doi: 10.1111/jgs.16274. [Epub ahead of print]

Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability.

Collaborators (208)

Pahor M, Guralnik JM, Anton SD, Buford TW, Leeuwenburgh C, Nayfield SG, Manini TM, Caudle C, Crump L, Holmes L, Lee J, Lu CJ, Miller ME, Espeland MA, Ambrosius WT, Applegate W, Beavers DP, Byington RP, Cook D, Furberg CD, Harvin LN, Henkin L, Hepler J, Hsu FC, Joyce K, Lovato L, Pierce J, Roberson W, Robertson J, Rushing J, Rushing S, Stowe CL, Walkup MP, Hire D, Rejeski WJ, Katula JA, Brubaker PH, Mihalko SL, Jennings JM, Chen SH, Pierce JJ, Chen H, Hadley EC, Romashkan S, Patel KV, Bethesda, Bonds D, McDermott MM, Spring B, Hauser J, Kerwin D, Domanchuk K, Graff R, Rego A, Church TS, Blair SN, Myers VH, Monce R, Britt NE, Harris MN, McGucken AP, Rodarte R, Millet HK, Tudor-Locke C, Butitta BP, Donatto SG, Cocreham SH, King AC, Castro CM, Haskell WL, Stafford RS, Pruitt LA, Yank V, Berra K, Bell C, Thiessen RM, Youngman KP, Virgen SB, Maldonado E, Tarin KN, Klaftenegger H, Prosak CA, Campero I, Garcia DM, Soto J, Chio L, Hoskins D, Fielding RA, Nelson ME, Folta SC, Phillips EM, Liu CK, McDavitt EC, Reid KF, Kirn DR, Pasha EP, Kim WS, Krol JM, Beard VE, Tsiroyannis EX, Hau C, Manini TM, Pahor M, Anton SD, Buford TW, Marsiske M, Nayfield SG, Sandesara BD, Black ML, Burk WL, Hoover BM, Knaggs JD, Marena WC, Korytov I, Curtis SD, Lorow MS, Goswami CS, Lewis MA, Kamen M, Bitz JN, Stanton BK, Hicks TT, Gay CW, Xie C, Morris HL, Singletary FF, Causer J, Yonce S, Radcliff KA, Smith MP, Scott JS, Rodriguez MM, Fitch MS, Dunn MC, Schllesinger JQ, Newman AB, Studenski SA, Goodpaster BH, Lopez O, Glynn NW, Nadkarni NK, Ives DG, Newman MA, Grove G, Williams K, Bonk JT, Rush J, Kost P, Vincent P, Gerger A, Romeo JR, Monheim LC, Kritchevsky SB, Marsh AP, Brinkley TE, Demons JS, Sink KM, Kennedy K, Shertzer-Skinner R, Wrights A, Fries R, Barr D, Gill TM, Axtell RS, Kashaf SS, de Rekeneire N, McGloin JM, Mautner R, Huie-White SM, Bianco L, Zocher J, Wu KC, Shepard DM, Fennelly B, Castro R, Halpin S, Brennan M, Barnett T, Iannone LP, Zenoni MA, Bugaj JA, Bailey C, Charpentier P, Hawthorne-Jones G, Mignosa B, Lewis L, Williamson J, Sink KM, Hendrie HC, Rapp SR, Verghese J, Woolard N, Espeland M, Jennings J, Wilson VK, Pepine CJ, Ariet M, Handberg E, Deluca D, Hill J, Szady A, Chupp GL, Flynn GM, Gill TM, Hankinson JL, Vaz Fragoso CA, Groessl EJ, Kaplan RM.

Author information

Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Preventive Medicine and Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois.
Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida.
Klein Buendel, Inc, Golden, Colorado.
Centre Muraz, Bobo-Dioulasso, Burkina Faso.
Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
Department of Health Research & Policy, and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.



Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study.


Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years.


LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD.


Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment.


Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual-paced 400-m walk every 6 months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates.


Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57-.90; P = .004) and PMMD (HR = .60; 95% CI = .44-.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05).


A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue.


exercise; fatigability; health education; older adults


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