BackgroundFalls and fall-related injuries are a serious public health issue. Exercise programs can effectively reduce fall risk in older people. The iStoppFalls project developed an Information and Communication Technology-based system to deliver an unsupervised exercise program in older people’s homes. The primary aims of the iStoppFalls randomized controlled trial were to assess the feasibility (exercise adherence, acceptability and safety) of the intervention program and its effectiveness on common fall risk factors.MethodsA total of 153 community-dwelling people aged 65+ years took part in this international, multicentre, randomized controlled trial. Intervention group participants conducted the exercise program for 16 weeks, with a recommended duration of 120 min/week for balance exergames and 60 min/week for strength exercises. All intervention and control participants received educational material including advice on a healthy lifestyle and fall prevention. Assessments included physical and cognitive tests, and questionnaires for health, fear of falling, number of falls, quality of life and psychosocial outcomes.ResultsThe median total exercise duration was 11.7 h (IQR = 22.0) over the 16-week intervention period. There were no adverse events. Physiological fall risk (Physiological Profile Assessment, PPA) reduced significantly more in the intervention group compared to the control group (F1,127 = 4.54, p = 0.035). There was a significant three-way interaction for fall risk assessed by the PPA between the high-adherence (>90 min/week; n = 18, 25.4 %), low-adherence (<90 min/week; n = 53, 74.6 %) and control group (F2,125 = 3.12, n = 75, p = 0.044). Post hoc analysis revealed a significantly larger effect in favour of the high-adherence group compared to the control group for fall risk (p = 0.031), postural sway (p = 0.046), stepping reaction time (p = 0.041), executive functioning (p = 0.044), and quality of life (p for trend = 0.052).ConclusionsThe iStoppFalls exercise program reduced physiological fall risk in the study sample. Additional subgroup analyses revealed that intervention participants with better adherence also improved in postural sway, stepping reaction, and executive function.Trial registrationAustralian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651International Standard Randomised Controlled Trial Number: ISRCTN15932647

The reproducibility of the 6-min walking test (6MWT) needs to be more solidly studied. This study aimed to investigate the reproducibility of two 6MWTs performed on subsequent days in a large and representative sample of patients with chronic obstructive pulmonary disease (COPD), and to quantify the learning effect between the two tests, as well as its determinants.In a retrospective observational study, 1,514 patients with COPD performed two 6MWTs on subsequent days. Other measurements included body composition (dual X-ray absorptiometry), dyspnoea (Medical Research Council scale) and comorbidity (Charlson index).Although the 6MWT was reproducible (intraclass correlation coefficient50.93), patients walked farther in the second test (391 m, 95% CI 155-585 m versus 418 m, 95% CI 185-605 m; p,0.0001). On average, the second 6MWT increased by 27 m (or 7%), and 82% of patients improved in the second test. Determinants of improvement o42 m in the second test (upper limit of the clinically important change) were as follows: first 6MWT ,350 m, Charlson index ,2 and body mass index ,30 kg?m -2 (OR 2.49, 0.76 and 0.60, respectively).The 6MWT was statistically reproducible in a representative sample of patients with COPD. However, the vast majority of patients improved significantly in the second test by an average learning effect of 27 m.KEYWORDS: Chronic obstructive pulmonary disease, 6-min walking test, reproducibility of results C hronic obstructive pulmonary disease (COPD) is a systemic disease characterised by progressive airflow limitation, exercise intolerance and physical inactivity [1,2]. Although the degree of airflow obstruction is frequently used as a marker of disease severity, it does not adequately reflect extrapulmonary manifestations of COPD [3,4]. Some modalities of field tests are available to assess these patients' exercise capacity [4], which better reflect the extrapulmonary features of the disease.The 6-min walking test (6MWT) is a simple and inexpensive test that provides a global and integrated response of both physical (pulmonary and nonpulmonary factors) and psychological factors [5,6]. The 6MWT is used to assess functional exercise capacity before and after interventions [7,8] and as a predictor of morbidity and mortality in COPD [9].In general, the 6MWT is a reliable test in COPD patients but a learning effect has been suggested [10-15], i.e. patients achieving a considerably higher walked distance when a second test is performed. Indeed, there is controversy about the size of the learning effect, which may range from 2.6% to 22% [10,11,[16][17][18][19][20]. Moreover, the external validity of the previous studies is limited due to the pre-specified inclusion criteria [10,11,13,18]. Furthermore, researchers usually used statistical analysis that did not demonstrate trends and agreement between both 6MWTs, thereby compromising the internal validity of the results [10]. Additionally, the determinants of improvement in walking distance remain unknown. Considering the importance of the 6...

BackgroundTo date, detailed analyses of walking patterns using accelerometers during the 6-min walk test (6MWT) have not been performed in patients with chronic obstructive pulmonary disease (COPD). Therefore, it remains unclear whether and to what extent COPD patients have an altered walking pattern during the 6MWT compared to healthy elderly subjects.Methodology/Principal Findings79 COPD patients and 24 healthy elderly subjects performed the 6MWT wearing an accelerometer attached to the trunk. The accelerometer features (walking intensity, cadence, and walking variability) and subject characteristics were assessed and compared between groups. Moreover, associations were sought with 6-min walk distance (6MWD) using multiple ordinary least squares (OLS) regression models. COPD patients walked with a significantly lower walking intensity, lower cadence and increased walking variability compared to healthy subjects. Walking intensity and height were the only two significant determinants of 6MWD in healthy subjects, explaining 85% of the variance in 6MWD. In COPD patients also age, cadence, walking variability measures and their interactions were included were significant determinants of 6MWD (total variance in 6MWD explained: 88%).Conclusions/SignificanceCOPD patients have an altered walking pattern during 6MWT compared to healthy subjects. These differences in walking pattern partially explain the lower 6MWD in patients with COPD.

The lack of a strong association between problematic ADLs and clinical determinants emphasizes the need for individualized assessment of these ADLs to allow tailored intervention.