Background and Aims: Vision is an important prerequisite for balance control and

Background In old age, decline in functioning may cause changes in walking ability. Our aim was to study whether older people who report adaptive, maladaptive, or no walking modifications differ in outdoor mobility. Methods Community-dwelling people aged 75–90 years (N = 848) were interviewed at baseline, of whom 761 participated in the 2-year follow-up. Walking modifications were assessed by asking the participants whether they had modified their way of walking 2 km due to their health. Based on the responses, three categories were formed: no walking modifications (reference), adaptive (eg, walking more slowly, using an aid), and maladaptive walking modifications (reduced frequency of walking, or having given up walking 2 km). Differences between these categories in life-space mobility, autonomy in participation outdoors, and unmet physical activity need were analyzed using generalized estimation equation models. Results Participants with maladaptive walking modifications (n = 238) reported the most restricted life-space mobility (β = −9.6, SE = 2.5, p < .001) and autonomy in participation outdoors (β = 1.7, SE = 0.6, p = .004) and the highest prevalence of unmet physical activity need (odds ratio = 4.3, 95% confidence interval = 1.1–16.5) at baseline and showed a decline in these variables over time. Those with no walking modifications (n = 285) at baseline exhibited the best values in all outdoor mobility variables and no change over time. Although at baseline those with adaptive walking modifications (n = 325) resembled those with no modifications, their outdoor mobility declined over time. Conclusion Adopting adaptive modifications may postpone decline in outdoor mobility, whereas the use of maladaptive modifications has unfavorable consequences for outdoor mobility.

Background Reductions in muscle strength and poor balance may lead to mobility limitations in older age. Aims We assessed the effects of long-term once-weekly strength and balance training (SBT) on muscle strength and physical functioning in a community-based sample of older adults. Methods 182 individuals [130 women and 52 men, mean age 80 (SD ± 3.9) years] underwent supervised SBT as part of the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Isometric knee extension and flexion strength, chair rise, maximal walking speed, timed up and go (TUG) and Berg Balance Scale (BBS) were measured at baseline, after 2-year training and at post intervention follow-up. A linear mixed model was used to examine the change in physical functioning over time. Results During the intervention, both women (2.5 s, p < 0.001) and men (1.4 s, p = 0.013) improved their chair rise capacity. Women's knee extension and flexion strength improved by 14.1 N (p = 0.003) and 16.3 N (p < 0.001), respectively. Their maximal walking speed also improved by 0.08 m/s (p < 0.001). In men, no changes in muscle strength or walking speed occurred during training or follow-up. No changes in BBS and TUG were observed at the end of the intervention, but decrease in BBS was observed at post-intervention follow-up in men. Conclusions In community-dwelling older adults with variety in health and functioning supervised strength and balance training once a week may help to prevent age-related decline in mobility and muscle strength.

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ObjectivesTo investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol.MethodsIn this non-blinded randomised controlled trial, 52 individuals aged 60–75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee.ResultsImprovement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by −1.9 s (95% CI, −2.9 to −1.0), while it changed by −0.6 s (95% CI −1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee.ConclusionIn patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful.Trial registration numberNCT03717727.

Objective. The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used and the risk of bias. Methods. A literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo and PEDro up to January 10, 2020. Studies with a Randomized Controlled Trial (RCT) design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and GRADE were used to estimate quality, treatment effect, covariates’ effect, and the certainty of evidence, respectively. Results. In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48) or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (SMD = −0.21; 95% CI = −0.36 to −0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (SMD = −0.32; 95% CI = −0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance. Conclusions. For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared to inactive comparison groups. To strengthen the evidence, further RCTs on the effectiveness of gamified exercise intervention are needed. Impact. Exergaming has effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.

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Twelve-month supervised home-based exercise had no effect on days lived at home vs. usual care in cases of frailty. It prevented decline in quality-of-life. The first years' increased healthcare costs were regained over the next year.