A group exercise program that incorporated timing and coordination exercises was more effective than a usual care exercise program at improving mobility in community-dwelling older adults, according to research published in JAMA Internal Medicine.
“Walking difficulty is a common, costly condition in older adults,” Jennifer S. Brach, PhD, PT, from the department of physical therapy at the University of Pittsburgh, and colleagues wrote. “Walking difficulty contributes to loss of independence, higher rates of morbidity, and increased mortality. Exercise is beneficial to physical and mental health and may prevent walking difficulty. Community based group exercise programs are one option for promoting health and wellness and could potentially be used to improve walking in older adults.”
Brach and colleagues evaluated the effectiveness of the On the Move exercise program, which focuses on timing and coordination of movement, at improving function, disability and walking ability of older adults compared with a usual care exercise program that focuses on seated strength, endurance and flexibility. They performed a cluster-randomized, single-blind intervention trial that included 298 participants who were 65 years or older (mean age, 80 years; 84.2% female; 83.6% white) from one of 32 independent living facilities, senior apartment buildings and senior community centers. Participants had a mean of 2.8 chronic conditions and were able to walk independently with a gait speed of at least 0.6 m/s, able to follow two-step commands and were medically stable.
Sites were randomly assigned to provide On the Move (n = 16; 152 participants) or usual care (n = 16; 146 participants). Baseline characteristics were similar between both intervention groups. The exercise classes were conducted twice a week for 12 weeks for a duration of 50 minutes. On the Move included warm-up, timing and coordination (eg, stepping and walking patterns), strengthening and stretching exercises, and the usual care program included warm-up, strength, endurance and stretching exercises. The researchers used the Late Life Function and Disability Instrument to assess self-reported function and disability and used 6-minute walking distance and gait speed to assess mobility.
Postintervention testing was completed by 93.4% of participants in On the Move and 95.2% in usual care. Mean improvements in gait speed (0.05 m/s vs. –0.01 m/s; adjusted difference = 0.05 m/s; P = .002) and 6-minute walk distance (20.6 m vs. 4.1 m; adjusted difference = 16.7 m; P = .03) were greater in the On the Move group than the usual care group. However, there was greater attendance in the usual care group than in the On the Move group (65.1% vs. 50% attended 20 classes; P = .03). No significant differences were observed for any other outcomes.
“Our findings support the idea that timing and coordination exercise should be included in group exercise programs to improve mobility in older adults,” Brach and colleagues concluded. “Individuals in [On the Move] did not report greater improvements in function and disability than the usual-care group. One possible explanation is that mobility performance improvement may not have reached a threshold that the older adults would recognize as affecting overall function and disability. Another possible explanation is that the intervention may need to be of a longer duration to affect function and disability.”
“Additional research examining the impact of the intervention on long-term disability outcomes is needed before routine implementation into clinical practice can be recommended,” they added. – by Alaina Tedesco
Disclosure: Brach reports no relevant financial disclosures. Please see full study for complete list of all other authors’ relevant financial disclosures.