Designing Clinical Trials of Interventions for Mobility Disability: Results From the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Trial

Espeland, Mark A.; Gill, Thomas M.; Guralnik, Jack M.; Miller, Michael E.; Fielding, Roger A.; Newman, Anne B.; Pahor, Marco

doi:10.1093/gerona/62.11.1237

Cited by 55 publications

(41 citation statements)

References 29 publications

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“…Eligible persons are 70 years and older; ambulatory with or without an assistive device; at high risk for disability defined using a short physical performance battery (SPPB) cut score of ≤9 [30] corresponding to frail range; and have a gait speed of ≤100 cm/s [31]. Box 1 includes a full list of inclusion and exclusion criteria.…”

Section: • Study Designmentioning

confidence: 99%

Cognitive Remediation to Enhance Mobility in Older Adults: the Crem Study

Ayers

Mahoney

Ambrose

et al. 2016

Neurodegener. Dis. Manag.

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Mobility disabilities represent the most prevalent disability among seniors. Emerging evidence indicates that executive functions play an important role in maintaining mobility. However, the use of cognitive remediation programs to enhance mobility has not been investigated in a full-scale randomized control trial. The CREM study is a single-blind randomized control trial to examine the effect of computerized cognitive remediation versus computer-based health education training on mobility in 420 seniors. The primary outcome is change in gait speed during normal walking and walking-while-talking conditions from baseline to postintervention. Secondary outcomes are change in mobility, mobility-related cognitive processes and neuroplasticity. Results of this study will fill an important gap in the efficacy and feasibility of cognitive remediation to improve mobility in seniors. Mobility disability, defined as severe difficulty or inability to walk a quarter of a mile or climb stairs, is associated with loss of independence and is an independent predictor of mortality in older adults [1,2]. While exercise is recommended to prevent mobility disability and improve gait speed [3], <10% of US seniors exercise at recommended levels [4] and 25% are inactive [1], necessitating exploration of new approaches to improve mobility.Intact gait control requires efficient integration of many neural systems, namely motor, sensory and cognitive, including multiple cognitive subsystems (i.e., memory, attention and executive functions [EFs]). EFs are a set of higher cognitive processes that modulate behavior, facilitate allocation Practice points• Given the major medical and socioeconomic consequences of disability in seniors and the low compliance with recommended treatments such as physical exercise, investigation of alternate strategies to improve mobility is a vital need.• We present a randomized clinical trial to test the efficacy of a computerized cognitive remediation program on improving mobility in sedentary seniors, a group at an especially high risk for disability.• The primary outcome is postintervention change in gait speed measured during normal-pace walking (simple locomotion) and walking-while-talking (complex locomotion) conditions.• This novel approach to improving mobility has the potential to shift treatment paradigms in the field of disability by introducing cognitive approaches to mobility that can be applied to prevention and rehabilitation in diverse settings.

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Section: • Study Designmentioning

confidence: 99%

Cognitive Remediation to Enhance Mobility in Older Adults: the Crem Study

Ayers

Mahoney

Ambrose

et al. 2016

Neurodegener. Dis. Manag.

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“…As the life expectancy of older adults continues to increase, prevention or postponement of age-associated mobility-disability is now of major public health importance (1,2). Elders who lose their mobility have higher rates of falls and injury, chronic disease, dependency, institutionalization, and mortality (2)(3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Lower extremity muscle mass predicts functional performance in mobility-limited elders

Reid

Naumova

Carabello

et al. 2008

The Journal of nutrition, health and aging

199

142

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Objectives-This study examined the influence of lower extremity body composition and muscle strength on the severity of mobility-disability in community-dwelling older adults.Methods-Fifty-seven older males and females (age 74.2 ± 7 yrs; BMI 28.9 ± 6 kg/m 2 ) underwent an objective assessment of lower extremity functional performance, the Short Physical Performance Battery test (SPPB). Participants were subsequently classified as having moderate (SPPB score > 7: n = 38) or severe mobility impairments (SPPB score ≤7: n = 19). Body composition was assessed using dual-energy X-ray absorptiometry and provided measures of bone mineral density (BMD), total leg lean mass (TLM) and total body fat. Maximal hip extensor muscle strength was estimated using the bilateral leg press exercise. Multiple logistic regression analysis was utilized to identify the significant independent variables that predicted the level of mobility-disability.Results-TLM was a strong independent predictor of the level of functional impairment, after accounting for chronic medical conditions, BMD, body fat, body weight and habitual physical activity. In a separate predictive model, reduced muscle strength was also a significant predictor of severe functional impairment. The severity of mobility-disability was not influenced by gender (p = 0.71). A strong association was elicited between TLM and muscle strength (r = 0.78, p < 0.01).Conclusions-These data suggest that lower extremity muscle mass is an important determinant of physical performance among functionally-limited elders. Such findings may have important implications for the design of suitable strategies to maintain independence in older adults with compromised physical functioning. Additional studies are warranted to assess the efficacy of lifestyle, exercise or therapeutic interventions for increasing lean body mass in this population.

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“…Gait speed is a widely used performance-based measure of mobility that is associated with functional status in older adults and is a more sensitive indicator of mobility disability than self-reported disability (10). Therefore in the current study we based mobility disability on annual timed walking performance and used receiver operating curves (ROC) analyses to support the cut-point of less than or equal to 0.55 m/s (11).…”

mentioning

confidence: 99%

Pulmonary Function, Muscle Strength, and Incident Mobility Disability in Elders

Buchman¹,

Boyle²,

Leurgans³

et al. 2009

Proceedings of the American Thoracic Society

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Muscle strength, including leg strength and respiratory muscle strength, are relatively independently associated with mobility disability in elders. However, the factors linking muscle strength with mobility disability are unknown. To test the hypothesis that pulmonary function mediates the association of muscle strength with the development of mobility disability in elders, we used data from a longitudinal cohort study of 844 ambulatory elders without dementia participating in the Rush Memory and Aging Project with a mean follow-up of 4.0 years (SD 5 1.39). A composite measure of pulmonary function was based on spirometric measures of forced vital capacity, forced expiratory volume, and peak expiratory flow. Respiratory muscle strength was based on maximal inspiratory pressure and expiratory pressure and leg strength based on handheld dynamometry. Mobility disability was defined as a gait speed less than or equal to 0.55 m/s based on annual assessment of timed walk. Secondary analyses considered time to loss of the ability to ambulate. In separate proportional hazards models which controlled for age, sex, and education, composite measures of pulmonary function, respiratory muscle strength, and leg strength were each associated with incident mobility disability (all P values , 0.001). Further, all three were related to the development of incident mobility disability when considered together in a single model Secondary analyses examining incident loss of the ability to ambulate revealed similar findings. Overall, these findings suggest that lower levels of pulmonary function and muscle strength are relatively independently associated with the development of mobility disability in the elderly.

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Designing Clinical Trials of Interventions for Mobility Disability: Results From the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Trial

Cited by 55 publications

References 29 publications

Cognitive Remediation to Enhance Mobility in Older Adults: the Crem Study

Cognitive Remediation to Enhance Mobility in Older Adults: the Crem Study

Lower extremity muscle mass predicts functional performance in mobility-limited elders

Pulmonary Function, Muscle Strength, and Incident Mobility Disability in Elders

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