Feasibility of a primary care-based adapted physical activity program for older adults with chronic conditions: the CAPA-CITY 70 pilot study

Technical Summary: CAPA-CITY 70 Pilot Study

Problem Statement
Despite the established efficacy of physical activity for healthy aging and chronic disease management, participation in structured programs remains insufficient among older adults (70+ years) with multimorbidity. Implementation barriers are multifactorial, affecting both healthcare professionals (lack of training, referral pathways, and knowledge of local resources) and patients (transportation, financial constraints, fear of injury, and low self-confidence). Existing models often fail to integrate physical activity into routine primary care pathways or address the specific logistical and financial hurdles faced by this vulnerable demographic.

Methodology
The CAPA-CITY 70 study was a monocentric, prospective, non-comparative, quasi-experimental pilot feasibility study conducted in Toulouse, France.

• Population: Community-dwelling adults aged 70 years or older with at least one long-term condition (long-term condition reimbursement status). Exclusion criteria included institutional residence, severe dependency (Katz score < 5.5), major cognitive impairment, or contraindications to physical activity.
• Intervention: A 4-month supervised Adapted Physical Activity (APA) program delivered at a dedicated local center. The program was integrated into a primary care pathway where General Practitioners (GPs) referred eligible patients. Key organizational features included neighborhood-based delivery and full financial coverage (no out-of-pocket costs) for participants.
• Outcomes:
  • Primary Endpoint: Feasibility, defined as the proportion of included participants who completed the 4-month program.
  • Secondary Endpoints: Adherence (session attendance), satisfaction (patient and GP), and exploratory changes in geriatric assessments (e.g., SPPB, ADL, MMSE), physical activity levels (GPAQ, Ricci-Gagnon), and quality of life (WHOQOL-BREF) at baseline, month 4, month 6, and month 12.
• Analysis: Descriptive statistics were used for feasibility and satisfaction. Exploratory repeated-measures analyses utilized Cochran's Q test for qualitative variables and Friedman's rank test for quantitative variables, without adjustment for multiple comparisons.

Key Results

• Recruitment and Completion: Of 37 included participants (mean age 79.1 years; 59.5% women), 30 started the program and 27 completed the 4-month intervention. This yielded a completion rate of 73.0% among all included participants and 90.0% among those who attended at least one session.
• Adherence: Adherence was high, with a median completion of 93.8% of proposed sessions. 56.7% of participants completed at least 90% of sessions.
• Satisfaction: Satisfaction was high. At month 12, 91.7% of respondents rated program organization as good or very good, and 79.2% rated the benefits as high or very high. All five participating GPs rated referral procedures and communication as very satisfactory, with 80% stating they would refer future patients.
• Clinical and Functional Outcomes:
  • Significant Change: A statistically significant improvement was observed in chair-stand performance over time (p = 0.017), with mean scores increasing from 2.9 at baseline to 3.7 at month 12.
  • Trends: Differences in self-reported exhaustion approached but did not reach statistical significance (p = 0.062).
  • Stability: Most other geriatric assessments (ADL, IADL, MMSE, balance, gait speed) and quality-of-life domains remained stable.
  • Social Relationships: A statistically significant difference was observed in the WHOQOL-BREF social relationships domain (p = 0.041), showing a decline over time. The authors note this may be influenced by the study period coinciding with the COVID-19 pandemic.
• Attrition: 12 participants exited prematurely. Those who did not complete follow-up were significantly more likely to have a malignant tumor at inclusion compared to completers (66.7% vs. 28.0%, p = 0.041).

Significance and Claims
The authors conclude that a local, primary care-based APA program for older adults with chronic conditions is feasible and acceptable. The study demonstrates that a model combining GP referral, neighborhood-based delivery, and full financial coverage can overcome common barriers to participation, resulting in high adherence and satisfaction even in a population with advanced age and multimorbidity.

The paper modestly frames these findings as a validation of the implementation model rather than proof of clinical effectiveness, citing the lack of a control group and small sample size. The authors suggest that the observed improvement in chair-stand performance warrants further investigation but cannot be definitively attributed to the intervention without a controlled trial.

Crucially, the study highlights that while functional gains (such as chair-stand performance) may be sustained, physical activity levels tended to decline after the supervised period ended. This supports the authors' assertion that adapted physical activity for this demographic should be conceptualized not as isolated short-term interventions but as longitudinal care pathways integrated into chronic disease management. The findings provide a basis for larger controlled studies to assess effectiveness, scalability, and long-term sustainability.