Diverse Exercises Similarly Reduce Older Adults’ Mobility Limitations

Abstract

Introduction/Purpose Little is known about the comparative effectiveness of exercise programs, especially when delivered at a high intensity, in mobility-limited older adults. We compared the effects of 25 sessions of high-intensity agility exergaming (EXE) and stationary cycling (CYC) at the same cardiovascular load on measured and perceived mobility limitations, balance, and health-related quality of life in mobility-limited older adults. Methods Randomized to EXE (n = 28) and CYC (n = 27), mobility-impaired older adults (age 70 yr) exercised five times per week for 5 wk at 80% of age-predicted maximal heart rate. Waitlisted controls did not exercise (n = 28). Results Groups did not differ at baseline in any outcomes (P > 0.05). The primary outcomes (The Short Form-36-Health Survey: EXE, 6.9%; effect size, 2.2; CYC, 5.5%, 1.94; Western Ontario and McMaster Universities Osteoarthritis Index: EXE, −27.2%, −3.83; CYC, −17.2, −2.90) improved similarly (P > 0.05). Secondary outcomes, including body mass (−3.7%), depression (−18%), and walking capacity (13.5%) also improved (P < 0.05) similarly after the two interventions. Activities of daily living, Berg Balance Score, BestTest scores, and Dynamic Gait Index improved more (P < 0.05) after EXE than CYC. Center of pressure of standing sway path improved in one of six tests only after EXE (P < 0.05). Postexercise cardiovascular response improved in EXE (P = 0.019). CON did not change in any outcomes (P > 0.05). Conclusions When matched for cardiovascular and perceived effort, two diverse high-intensity exercise programs improved health-related quality of life, perceived mobility limitation, and walking capacity similarly and balance outcomes more in mobility-limited older adults, expanding these older adults’ evidence-based exercise options to reduce mobility limitations.

Effects of Exercise Dose and Detraining Duration on Mobility at Late Midlife: A Randomized Clinical Trial

“…Because exercise duration was the dosing factor in the intervention, which was delivered at a high intensity (rate of perceived exertion can reach ∼16 of 20 [17, 18]), we set the 6-minute walk test (6MWT) as the primary outcome. The 6MWT is a reliable and valid measure of walking capacity that is sensitive to change [19].…”

Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People

“…Five studies evaluated the overall impact of VRSs on BADLs [ 33 , 34 , 35 , 36 , 37 ] and three studies examined IADLs [ 38 , 39 , 40 ]. We also identified six studies which assessed the effectiveness of VRSs on the capacity to make transfers and twenty-one studies which reported on their effectiveness in improving functional ambulation.…”

“…As Figure 2 a shows, the effect size of VRSs in improving the performance of BADLs is moderate but significant; the total SMD was 0.61 (95% CI: −0.15; 1.37). Four of the studies which assessed effectiveness on BADLs obtained a large effect (d > 0.8) [ 33 , 34 , 35 , 37 ] and two studies found a medium effect [ 33 , 38 ]. However, the effectiveness of VRSs was smaller for the three studies which assessed IADLs [ 38 , 39 , 40 ].…”

“… Stanmore 2019 [ 45 ] Level I RCT n = 106 EC = 56 CC = 50 78 (58–96) 78 % Female >55 years; mental capacity; able to speak English; able to watch television from 2 m distance; able to use VR Assisted living facilities Manchester and Glasgow, UK Exergame FAME OTAGO 12 weeks Physical exercise BBS; FES TUG; GDS No follow-up VR exergame improved balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities. Tollar 2019 [ 37 ] Level I RCT n = 83 EC-CYC = 27 EC-EXE = 28 CC = 28 69.6 (66–72) 53% Female >60 years; >24 MMSE; >40 BDI; mobility difficulty Hospital Somogy, Hungary Xbox or bicycle ergometer 5 weeks 5 times/week Usual routine activities 6MWT; SE-ADL; DGI; MAP; SF-36; WOMAC No follow-up Xbox and cycling improved general health-related QoL and walking capacity. Xbox improved the SE-ADL (7.3%) Gomes 2019 [ 41 ] Level I RCT n = 30 EC = 15 CC = 15 84 (78–90) 93% female >60 years; able to walk independently; normal or corrected visual acuity; good hearing; no previous experience with VR Sao Paulo Brazil Hospital Ninten...…”

“…The risk of bias for functional mobility and transfers was high (Figure 3). In functional ambulation, four studies had a high risk of bias for random sequence generation [35,[48][49][50], none of the studies could blind participants, only six blinded outcome assessors [37,38,41,47,51,52] and only one had a low risk of bias for allocation concealment. On the other hand, loss to follow-up was significant in only one study (Keogh et al, 2014).…”