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

Abstract

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

Psychometric properties of instrumented postural sway measures recorded in community settings in independent living older adults

“…This was an ancillary study to a cluster randomized clinical trial (RCT) that investigated the effect of two different group exercise programs conducted at their residence facility on walking ability, disability and self-reported function [13]. This study took place from April 2014 to May 2016.…”

“…This study has been approved by the Institutional Review Board of the University of Pittsburgh. Inclusion and exclusion criteria followed that of the parent study [13,14].…”

Psychometric Properties of Instrumented Postural Sway Measures Recorded in Community Settings in Independent Living Older Adults

“…This was an ancillary study to a cluster randomized clinical trial (RCT) that investigated the effect of two different group exercise programs on walking ability, disability and self-reported function [13].…”

“…This study has been approved by the institutional review board of the University of Pittsburgh. Inclusion and exclusion criteria followed that of the parent study [13].…”

Geriatrics Literature 2017 Year in Review

“…Brach JS, Perera S, Gilmore S et al Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community‐Dwelling Older Adults: A Randomized Clinical Trial. JAMA Intern Med 2017;177:1437–1444 …”