Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger: LOB = -2.0 +/- 0.3 (adjusted paired differences, P < .005 ANOVA); SST = 7.0 +/- 1.2 sec; and FBOS = 9.0 +/- 2.0% of foot length (P < .05). Strengthening increased ISOK by 1.1 +/- 0.1 Nm kg-1 (P < .005). There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.

These results suggest that damage to discrete frontal and occipitoparietal periventricular white matter locations may be associated with a mobility disorder of aging.

Background High blood pressure (BP) is a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain that has been associated with functional decline in mobility and cognition in older people. Methods and Results This was a prospective cohort of subjects 75-89 years to determine relations among vascular risk factors, white matter hyperintensity volume (WMHs), and functional status. 99 subjects were enrolled using a balanced 3×3 matrix stratified by age and mobility performance and 72 subjects completed all sets of baseline and follow-up studies at 2 years. Subjects were excluded if there were medications, systemic or neurologic diseases that could compromise mobility. Ambulatory and clinic BP monitoring, magnetic resonance imaging (MRI), gait studies and neuropsychological testing were performed at baseline and after 24 months. Brain classification into normal white matter and T2-hyperintense WMH was performed using semi-automated segmentation. Quantitative measures of mobility and cognitive function were obtained longitudinally. Increased ambulatory systolic BP, but not clinic systolic BP, from baseline to 24 month follow-up was associated with increased WMH over that same period, as as well as measures of executive function/processing speed. Similar associations were observed for 24 hour BP, awake BP, and sleep BP, but not the surge between the sleep and awake time at the 24 month time point. Conclusions These data demonstrate for the first time the importance of 24-hour systolic BP in the progression of brain WMH burden associated with impairment of cognitive function in older people. The 24-hour systolic BP may be a potential target for intervention in the elderly to reduce vascular disease of the brain and impairment of function.