EFFECTIVENESS OF MOTOR SKILL OF WALKING GROUP EXERCISE IN OLDER ADULTS: A CLUSTER RANDOMIZED TRIAL

摘要

Many standard group exercise programs emphasize muscle strengthening, flexibility and general conditioning because of the association of such impairments with walking difficulties, but do not emphasize the ability to walk or the timing and coordination of movement that is critical to walking. We developed a group exercise program that includes timing and coordination exercises for walking called On the Move (OTM). In a single blind cluster-randomized trial, we evaluated the effectiveness of OTM and standard group programs to improve mobility, function and disability in 32 independent living facilities, community centers and senior apartment buildings. Programs were 1 hour, twice weekly for 12 weeks and ≤10 participants per class. OTM consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening and stretching exercises. The standard program consisted of warm-up, aerobic, strengthening and stretching exercises. 298 participants (mean age 80.0 ± 8.1 years) were randomized, and groups were not significantly different at baseline. Despite a lower rate of attending 80+% of classes (50% vs 65%; p=0.0324), OTM elicited greater gains than the standard program in gait speed (0.05 m/s; p=0.0022) and 6-minute walk distance (16.7 m; p=0.0344), but not in function and disability (Late Life Function/Disability Index). Exploratory subgroup analyses suggest those with better mobility at baseline (gait speed > 0.8 m/s and 6-minute distance farther than 300m) may elicit greater benefits from OTM than the standard program. A group exercise program that addresses the motor skill of walking is more effective than a standard strength and conditioning program in improving mobility.