Background-Although basic research has uncovered biological mechanisms by which exercise could maintain and enhance adult brain health, experimental human studies with older adults have produced equivocal results.

IMPORTANCE Chronic low back pain (LBP) is the most prevalent chronic pain in adults, and there is no optimal nonpharmacologic management. Exercise is recommended, but no specific exercise-based treatment has been found to be most effective.OBJECTIVE To determine whether an exercise-based treatment of person-specific motor skill training (MST) in performance of functional activities is more effective in improving function than strength and flexibility exercise (SFE) immediately, 6 months, and 12 months following treatment. The effect of booster treatments 6 months following treatment also was examined. DESIGN, SETTING, AND PARTICIPANTSIn this single-blind, randomized clinical trial of people with chronic, nonspecific LBP with 12-month follow-up, recruitment spanned December 2013 to August 2016 (final follow-up, November 2017), and testing and treatment were performed at an academic medical center. Recruitment was conducted by way of flyers, physician and physical therapy offices, advertisements, and media interviews at Washington University in St Louis, Missouri. Of 1595 adults screened for eligibility, 1301 did not meet the inclusion criteria and 140 could not be scheduled for the first visit. A total of 154 people with at least 12 months of chronic, nonspecific LBP, aged 18 to 60 years, with modified Oswestry Disability Questionnaire (MODQ) score of at least 20% were randomized to either MST or SFE. Data were analyzed between December 1, 2017, and October 6, 2020.INTERVENTIONS Participants received 6 weekly 1-hour sessions of MST in functional activity performance or SFE of the trunk and lower limbs. Half of the participants in each group received up to 3 booster treatments 6 months following treatment. MAIN OUTCOMES AND MEASURESThe primary outcome was the modified Oswestry Disability Questionnaire (MODQ) score (0%-100%) evaluated immediately, 6 months, and 12 months following treatment.RESULTS A total of 149 participants (91 women; mean [SD] age, 42.5 [11.7] years) received some treatment and were included in the intention-to-treat analysis. Following treatment, MODQ scores were lower for MST than SFE by 7.9 (95% CI, 4.7 to 11.0; P < .001). During the follow-up phase, the MST group maintained lower MODQ scores than the SFE group, 5.6 lower at 6 months (95% CI, 2.1 to 9.1) and 5.7 lower at 12 months (95% CI, 2.2 to 9.1). Booster sessions did not change MODQ scores in either treatment.CONCLUSIONS AND RELEVANCE People with chronic LBP who received MST had greater short-term and long-term improvements in function than those who received SFE. Person-specific MST in functional activities limited owing to LBP should be considered in the treatment of people with chronic LBP.

When presented with 2 treatment options, a majority of patients preferred SF over MST. Convenience was a particularly important attribute affecting preference. Assessing treatment preference and attributes prior to treatment initiation allows the clinician to identify factors that may need to be addressed to enhance adherence to, and outcomes of, treatment.

Background Traditional exercise programs for older adults, which focus on aerobic and strength training, have had only modest effects on walking. Recently, a motor learning exercise program was shown to have greater effects on walking when compared to a traditional exercise program. Translating this novel motor learning exercise program into a group exercise program would allow it to be offered as an evidence-based community-based program for older adults. Objective To translate a walking rehabilitation program based on motor learning theory from one-on- one to group delivery (On the Move©) and evaluate multiple aspects of implementation in older adults with impaired mobility. Design The translation process involved multiple iterations including meetings of experts in the field (Phase I), focus groups (Phase II) and implementation of the newly developed program (Phase III). Phase III was based on a one- group model of intervention development for feasibility, safety, potential effects and acceptability. Setting Community sites including two independent living facilities, an apartment building and a community center. Participants Adults 65 years of age or older who could ambulate independently and who were medically stable. Thirty-one adults, mean age 82.3±5.6 years, were eligible to participate. Methods The group exercise program was held twice a week for twelve weeks. Main Outcome Measurements Acceptability of the program was determined by retention and adherence rates and a satisfaction survey. Risk was measured by adverse events and questions on perceived challenge and safety. Mobility was assessed pre and post intervention by gait speed, figure of eight walk test (F8WT), and six minute walk test (6MWT). Results Modifications to the program included adjustments to format/length, music, education, and group interaction. The 12 week program was completed by 24/31 entrants (77%). Adherence was high with participants attending on average 83% of the classes. Safety was excellent with only one subject experiencing a controlled non-injurious fall. There was preliminary evidence for improved mobility after the intervention: gait speed improved from 0.76±.21 to 0.81±.22 m/s, p=.06; Figure 8 Walk Test from 13.0±3.9 to 12.0±3.9 s, p=.07; and Six Minute Walk Test from 246±75 to 281±67 meters, p=.02. Conclusions The group-based program was safe and acceptable to older adults with impaired mobility and resulted in potentially clinically meaningful improvements in mobility.

Background: Patients' pretreatment preferences can influence outcomes of nonpharmacologic treatments for musculoskeletal pain. Less is known about how patients' treatment preferences change following exposure to treatment. Objective: To examine the effect of exposure to treatment and change in disability and pain on treatment preference ratings of two exercise-based treatments for people with chronic low back pain (LBP). Design: Secondary analysis of a subsample of participants from a randomized clinical trial. Setting: Academic research setting. Participants: Individuals with chronic LBP (n = 83). Interventions: 6 weekly sessions of motor skill training (MST) or strength and flexibility exercise (SFE).Main Outcome Measures: Prior to treatment, participants completed a treatment preference assessment measure (TPA) describing MST and SFE. Participants rated four attributes (effectiveness, acceptability/logicality, suitability/appropriateness, convenience) of each treatment on a 5-point Likert scale (0-4) with higher scores indicating higher ratings. An overall preference rating was calculated as the mean of the attribute ratings. The TPA was administered 12 months post treatment to reassess participants' ratings of the treatment they received. Results: Participants who received MST rated their preference for MST higher 12 months post treatment and participants who received SFE rated their preference for SFE lower. Smaller improvements (to worsening) in pain were associated with a reduction in preference ratings in the SFE group, whereas the MST group generally increased their ratings regardless of pain. Changes in disability were not related to changes in preference ratings. Conclusions: Participants changed their preference ratings of two exercisebased treatments for LBP after exposure to the treatment. Participants who received the less familiar MST viewed this treatment more favorably 12 months post treatment, and this change was less contingent on changes in disability/ pain than for participants in the SFE group. Assessing preference ratings at various times during treatment is crucial to understand a person's preference for and perceptions of a treatment.