The gift of life
More than 1,600 older adults took part in the trial phase of the Lifestyle Interventions and Independence for Elders, or LIFE, study. The LIFE study sought to discover what happened when older adults engaged in moderate physical activity. In this month’s issue of The POST, we follow what happened to one of these study participants during the course of the trial.
By Morgan Sherburne
Brian Ainsworth participated in the LIFE study at UF Health.
Back in 2010, Brian Ainsworth had a problem with depression.
A pilot, Ainsworth gave up his small plane after his son expressed concerns.
“Pilots are responsible for their own safety. I just didn’t think it was safe,” Ainsworth says. “I told my son I thought I would get over this depression real soon. He said, ‘You can get another airplane if that happens.’”
Ainsworth, now 79, was taking medication for the depression, but one type of medication left him unable to sleep. Another medication made him sleep all day.
“Then she put me on something else and I had dry mouth, and on and on,” Ainsworth says. “Finally, she thought she had me on the right thing, and I said, ‘You’ve gotta get me off of this stuff.’”
His doctor told him she had been weaning him off his medication — she just had not told him.
“I was feeling better,” Ainsworth says.
Then, his doctor had another suggestion: a study, taking place at UF Health, which was to examine the effects of physical activity in people over the age of 70.
“She said, ‘Here’s a flier. See if they will accept you.’”
The LIFE study
For more than a decade, researchers have been addressing what seems like a fundamental question: If an older adult engages in moderate physical activity, will he or she continue to be mobile? Will he or she be healthier?
The Lifestyle Interventions and Independence for Elders, or LIFE, study was the largest of its kind — more than 1,600 older adults took part in the nearly three-year-long trial phase of the study at eight different field centers across the country.
Led by Marco Pahor, M.D., director of the UF Institute on Aging, the study was more than 10 years in the making. Previous pilot studies looked at smaller groups of older adults and refined the trial process.
In the LIFE study, the 1,635 older adults were randomly assigned to one of two groups. The first group performed moderate physical activity, including walking and light strength, flexibility and balance training. The second group attended health education classes and performed stretching exercises.
Every six months, staff members checked the participants’ ability to walk, their body weight, blood pressure and pulse rate. The staff members did not know whether the participants were in the physical activity group or the group receiving
educational classes.
Ainsworth didn’t say it out loud, but he did not want to be placed into the educational classes.
He walked occasionally on his own but used a cane when he was walking. Ainsworth told his neighbors the cane was to fend off dogs, but he had fallen a couple times. He wanted to be in better shape and also wanted to see how exercise would affect his depression.
Ainsworth was happy to find he had been assigned to the exercising group. He jumped into the physical activity with vigor.
“I started feeling better, and right away, started walking two times a week at home when I wasn’t in class,” Ainsworth says. “One month, I walked an hour every single day.”
During the winter, he had a tough time walking outside; during the summer, he walked in the evenings, when it’s cooler.
Ainsworth expressed admiration for the instructor who led the physical activity program, saying the leader worked sensitively with participants who were new to physical activity.
“He was incredible with all of us,” Ainsworth says.
The first results and a group leader
The first research paper to come from the LIFE study was published in May in Journal of the American Medical Association and revealed at the American College of Sports Medicine’s annual conference.
This research established for the first time that physical activity — for Ainsworth and his cohorts, this was 150 minutes of moderate-intensity walking per week as well as 20 to 30 minutes of resistance exercises — helps older adults remain mobile. Some of the resistance exercises included movements that mimic standing up from and sitting down into a chair, an important move that requires both strength and balance.
The results were significant: At the end of the study, moderate physical activity helped aging adults maintain their ability to walk at a rate 18 percent higher than those who did not exercise. There was a 28 percent reduction in people permanently losing the ability to walk easily.
Ainsworth became further embedded in the study. He’s outgoing, which his instructor noticed.
“About four or five months into the study, he pulled me aside and said, ‘You’re very valuable to this program because you’re acting as a mentor and you’re encouraging these people,’” Ainsworth says.
The staff could be supportive of the participants, but didn’t exhort them.
“But I could get away with that,” Ainsworth says. “I would walk with one of the members of the class, and I’d ask, ‘How long did you walk on Monday?’ They’d say, ‘25 minutes.’ I’d say, ‘Terrific. When are you going to shoot for 30?’”
A few weeks later, Ainsworth would surprise his fellow walkers by checking back in with them and remembering their goals.
“And that was kind of fun. I felt like I was contributing to them, which made me feel better toward them, myself and the program,” Ainsworth says.
About 10 months into Ainsworth’s participation in the study, he realized something: He had been off his antidepression medication for about a month.
“I didn’t feel near as depressed, and I was crediting the program with that,” Ainsworth says.
With his trainer’s encouragement, Ainsworth began working out on his own. He invested in a gym membership and spent an hour and a half about three times each week there, and walked through his neighborhood. Ainsworth enjoyed not only the extra exercise, but also getting to know his neighbors.
A hidden population
The LIFE study is novel in that it focuses on people typically ignored by other studies, Pahor says. The participants in the LIFE study were selected because they were sedentary and at risk of losing the ability to walk 400 meters or more. Four hundred meters is a walk around your neighborhood block or a stroll from your car to the supermarket. Losing that ability puts people at risk of being hospitalized at a greater rate and being admitted into nursing homes sooner and more frequently. Low physical performance can also lead to development of other diseases and the risk of death at a younger age.
Because of this, this population of older adults is typically ignored, Pahor said. They are difficult to recruit, and because they occasionally experience hospitalizations, can be difficult to retain in studies that extend over a long period of time.
“But that’s exactly how we selected these people,” Pahor says. “These are patients we see every day. This is why this study is so important because it includes a population that is typically understudied.”
Partway through the class, Ainsworth took a five-week trip through the western United States. He and his wife, Shirley, own a photo and framing business, Harmon’s, in Gainesville. Ainsworth began his photography career 64 years ago as an Associated Press photographer in Boston before starting a business printing photos and weathering the transition from film to digital.
When he returned from the trip, his doctor became concerned about a few small sores near his nose. A dermatologist estimated the sores had been on his face for several years.
“I should have taken care of the little sores, but the one on my nose was just tiny — the head of a pin — but that was the most damaging one,” Ainsworth says.
The sores turned out to be basal cell carcinoma. Ainsworth’s nose had to be removed.
“If that don’t throw you back into depression,” Ainsworth says. “I was scared to death.”
Ainsworth underwent the operation, and was referred to a plastic surgeon in Gainesville to reconstruct his nose. Over three more surgeries during a 90-day period, the surgeon used a flap of skin cut from Ainsworth’s forehead and kept nourished by a blood vein lifted from his shoulder.
With his nose gone, Ainsworth had no sense of smell — and therefore no appetite. He lost nearly 50 pounds in five weeks, dropping to 144 pounds from 190.
“It got scary,” he says.
He began eating five small meals a day and his weight rose to 152. Meanwhile, the exercise group that Ainsworth supported rallied around him.
“The class kept up with my progress afterward. They were very supportive,” Ainsworth says. “I came in for the first time after the second surgery, and it was still kind of bad. The class kind of looked at me and said, ‘Gee, this is really quite a major thing.’”
Today, Ainsworth’s surgery is hardly noticeable. He has to point out the scars where his plastic surgeon carved a nose from the skin of his forehead. A casual observer would notice nothing. He has regained some of his sense of smell.
A group focus
The LIFE study’s trial section ended in December 2013. After the initial results’ publication in May, dozens of studies have been and are being planned around the data collected during this period of time, including the effects of exercise on emotional well being, Pahor says.
As for Ainsworth, he has just one recommendation: that the LIFE study continues.
“It’s not that we need somebody — Uncle Sam — to put together an exercise group for us,” he says. “But what we needed to do is a continuation of what we were doing — not only exercising, but supporting everybody socially.”
Pahor says Ainsworth’s inclination is true, not only in the physical activity group, but the health education group as well.
“Several studies have demonstrated the benefits of socialization on health outcomes as we age,” Pahor says. “We believe that the socialization component accounted for some of the health benefits in both groups of the LIFE study.”
Some of the members of Ainsworth’s class are doing just that — at The Oaks Mall in Gainesville. Ainsworth himself has yet to join. He was a member of a gym that recently closed, but has lined up a membership to another gym. As for the group at Oaks Mall?
“There are two benefits to walking there,” Ainsworth said. “The temperature is the same all the time, and Chick-fil-A opens early.”