Improving Motor Control in Walking: A Randomized Clinical Trial in Older Adults With Subclinical Walking Difficulty

Brach, Jennifer S.; Lowry, Kristin A.; Perera, Subashan; Hornyak, Victoria; Wert, David; Studenski, Stephanie A.; VanSwearingen, Jessie M.

doi:10.1016/j.apmr.2014.10.018

Cited by 43 publications

(38 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, recent clinical trials from Brach et al and VanSwearingen et al have shown that motor skill gait training, which targets specific gait characteristics through repetitive practice of timing and coordination of gait, can improve gait speed and improve the energy cost of walking more efficiently than a standard walking and strengthening program. [25–27]…”

Section: Discussionmentioning

confidence: 99%

Altered spatiotemporal characteristics of gait in older adults with chronic low back pain

et al. 2017

View full text Add to dashboard Cite

Previous studies in older adults have identified that chronic low back pain (CLBP) is associated with slower gait speed. Given that slower gait speed is a predictor of greater morbidity and mortality among older adults, it is important to understand the underlying spatiotemporal characteristics of gait among older adults with CLBP. The purposes of this study were to determine (1) if there are differences in spatiotemporal parameters of gait between older adults with and without CLBP during self-selected and fast walking and (2) whether any of these gait characteristics are correlated with performance of a challenging walking task, e.g. stair negotiation. Spatiotemporal characteristics of gait were evaluated using a computerized walkway in 54 community-dwelling older adults with CLBP and 54 age- and sex-matched healthy controls. Older adults with CLBP walked slower than their pain-free peers during self-selected and fast walking. After controlling for body mass index and gait speed, step width was significantly greater in the CLBP group during the fast walking condition. Within the CLBP group, step width and double limb support time are significantly correlated with stair ascent/descent times. From a clinical perspective, these gait characteristics, which may be indicative of balance performance, may need to be addressed to improve overall gait speed, as well as stair-climbing performance. Future longitudinal studies confirming our findings are needed, as well as investigations focused on developing interventions to improve gait speed and decrease subsequent risk of mobility decline.

show abstract

Section: Discussionmentioning

confidence: 99%

Altered spatiotemporal characteristics of gait in older adults with chronic low back pain

et al. 2017

View full text Add to dashboard Cite

show abstract

“…[7][8][9]11 Previously, therapeutic, individually supervised exercise led by physical therapists that includes timing and coordination components has been shown to improve walking in older adults. [13][14][15][16] Therefore, timing and coordination exercises could be an important addition to community-based health promotion group exercise programs to improve walking. Based on previous research, 14,15 and with critical input from older adults and other stakeholders, the On the Move (OTM) group-based exercise program that includes timing and coordination and focuses on improving walking was developed.…”

mentioning

confidence: 99%

Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults

et al. 2017

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults.OBJECTIVE To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults.DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable. INTERVENTIONS Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises. MAIN OUTCOMES AND MEASURES The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals. RESULTS Participants (mean [SD] age, 80.0 [8.1] years) were mostly female (251 [84.2%]) and white (249 [83.6%]) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 [0.13] vs −0.01 [0.11] m/s; adjusted difference = 0.05 [0.02] m/s; P = .002) and 6-minute walk distance (20.6 [57.1] vs 4.1 [55.6] m; adjusted difference = 16.7 [7.4] m; P = .03). Attendance was greater in the usual-care program compared with On the Move (95 [65.1%] vs 76[50.0%] attended Ն20 classes; P = .03). There were no significant differences in any of the other primary or secondary outcomes. CONCLUSIONS AND RELEVANCEThe On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01986647

show abstract

“…We based sample size on pilot studies,(45–47) two-tailed α=0.05 tests, an attrition rate of 10% , a class size of 10 participants, intra-cluster correlation of 0.1, published methodologies and commercially available sample size and power software (PASS 2002 ® Number Cruncher Statistical Systems, Kayesville, Utah), and ability to detect clinically meaningful(48) or moderate effect sizes (Cohen’s d =0.5). (49) We estimated that 90 participants per arm would allow us, with 80% statistical power, to detect statistical significance of a difference as small as 3.1 points in LLFDI overall function change between the two interventions; 80 per arm for 3.2 points in LLFDI disability frequency; 140 per arm for 0.1 m/s in gait speed; and 40 per arm for 50m in six-minute walk distance.…”

Section: Methodsmentioning

confidence: 99%

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “ On the Move ” group exercise program in community-dwelling older adults

Brach

Perera

Gilmore

et al. 2016

Contemporary Clinical Trials

Self Cite

View full text Add to dashboard Cite

Background Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises. Methods The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the “On the Move” group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12 weeks delivered by study exercise leaders and facility activity staff personnel. Outcomes The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed. Stakeholders Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations. Summary A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice.

show abstract

Improving Motor Control in Walking: A Randomized Clinical Trial in Older Adults With Subclinical Walking Difficulty

Cited by 43 publications

References 54 publications

Altered spatiotemporal characteristics of gait in older adults with chronic low back pain

Altered spatiotemporal characteristics of gait in older adults with chronic low back pain

Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “ On the Move ” group exercise program in community-dwelling older adults

Contact Info

Product

Resources

About