Characteristics associated with gait speed improvements from walking interventions for older adults: A responder analysis.

Background: Some older adults benefit to a great degree from walking interventions and others experience little improvement. Understanding the personal characteristics associated with greater treatment response to different interventions could assist clinicians in providing patients with matched interventions to optimize both outcomes and resource use.

Research Question: What personal characteristics are associated with improved gait speed for older adults participating in walking interventions?

Methods: This was a secondary analysis of 236 older adults from a trial comparing "Standard" (lower-extremity strength and walking endurance) to "Plus" (additional task-specific training for walking) interventions on gait speed in older adults (≥65 years).

On the Move in the community: Protocol for a hybrid 1 trial examining effectiveness and fidelity of a community-based group exercise program for older adults.

Background: On the Move (OTM), a group exercise program to improve mobility in older adults, is efficacious when delivered by research staff. The next step in the development of OTM as a fully implementable intervention is to conduct an effectiveness study in which the intervention is delivered in community settings by community providers.

Methods: We describe the methods of a hybrid 1 cluster randomized, single-blind, intervention trial to compare the effectiveness of OTM to a delayed intervention control in 502 community-dwelling older adults across 44 sites.

Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial.

Importance: Standard exercise interventions targeting underlying physiologic system impairments have limited success in improving walking. Augmenting standard interventions with timing and coordination training, which incorporates the principles of motor learning and integrates multiple systems, may be more successful.

Objective: To determine whether a standard strength and endurance program incorporating timing and coordination training (standard-plus) improves gait speed more than strength and endurance training alone.

Association Between Improved Mobility and Distal Health Outcomes.

Background: We examined the association between improved mobility and distal health outcomes in older adults using secondary analysis of data from a cluster-randomized controlled group exercise trial.

Methods: Participants were 303 men and women aged ≥65 and older in 32 independent living facilities, senior apartments, and community centers who participated in 12-week group exercise interventions. Included were those who completed ≥1 follow-up phone call regarding outcomes assessment in the following year.

Program to improve mobility in aging (PRIMA) study: Methods and rationale of a task-oriented motor learning exercise program.

Walking difficulty is a common and costly problem in older adults. A potentially important yet unaddressed strategy to enhance walking ability through exercise intervention is to add a timing and coordination component in gait training (i.e.

Randomized Controlled Trial of Exercise to Improve Walking Energetics in Older Adults.

Background And Objectives: Mobility limitation is common and has been linked to high energetic requirements of daily activities, including walking. The study objective was to determine whether two separate forms of exercise could reduce the energy cost of walking and secondary outcomes related to activity and participation domains among older adults with mobility limitation.

Research Design And Methods: Community-dwelling older adults with self-reported mobility limitation ( = 72) were randomized to 12 weeks of twice-weekly, group-based, instructor-led timing and coordination, aerobic walking, or stretching and relaxation (active control) programs.

The Effect of Auditory Cueing on the Spatial and Temporal Gait Coordination in Healthy Adults.

Walk ratio, defined as step length divided by cadence, indicates the coordination of gait. During free walking, deviation from the preferential walk ratio may reveal abnormalities of walking patterns. The purpose of this study was to examine the impact of rhythmic auditory cueing (metronome) on the neuromotor control of gait at different walking speeds.

Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults: A Randomized Clinical Trial.

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.

Motor sequence learning-induced neural efficiency in functional brain connectivity.

Previous studies have shown the functional neural circuitry differences before and after an explicitly learned motor sequence task, but have not assessed these changes during the process of motor skill learning. Functional magnetic resonance imaging activity was measured while participants (n=13) were asked to tap their fingers to visually presented sequences in blocks that were either the same sequence repeated (learning block) or random sequences (control block). Motor learning was associated with a decrease in brain activity during learning compared to control.

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.

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.

Challenging the motor control of walking: Gait variability during slower and faster pace walking conditions in younger and older adults.

Background: Gait variability is a measure of motor control of gait. Little is known about age-related changes in the motor control of gait (gait variability) during challenging walking conditions, such as slower and faster pace walking.

Objective: The purpose of this study was to examine the impact of challenging walking conditions (slower and faster speeds) on gait variability in younger and older adults.

The test-retest reliability and minimal detectable change of spatial and temporal gait variability during usual over-ground walking for younger and older adults.

Gait variability is a marker of gait performance and future mobility status in older adults. Reliability of gait variability has been examined mainly in community dwelling older adults who are likely to fluctuate over time. The purpose of this study was to compare test-retest reliability and determine minimal detectable change (MDC) of spatial and temporal gait variability in younger and older adults.

Translation of a Motor Learning Walking Rehabilitation Program Into a Group-Based Exercise Program for Community-Dwelling Older Adults.

Background: Traditional exercise programs for older adults, which focus on aerobic and strength training, have had only modest effects on walking. Recently, a motor learning exercise program was shown to have greater effects on walking compared with a traditional exercise program. Translating this novel motor learning exercise program into a group exercise program would allow it to be offered as an evidence-based, community-based program for older adults.

The impact of testing protocol on recorded gait speed.

Background: Gait speed predicts disability, cognitive decline, hospitalization, nursing home admission and mortality. Although gait speed is often measured in clinical practice and research, testing protocols vary widely and their impact on recorded gait speed has yet to be explored.

Objectives: Our purpose is to describe and compare gait speeds obtained from different testing protocols in the same individuals.

Improving motor control in walking: a randomized clinical trial in older adults with subclinical walking difficulty.

Objective: To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait.

Design: Single-blinded randomized clinical trial.

Setting: University research laboratory.

Callosal hyperintensities and gait speed gain from two types of mobility interventions in older adults.

Objective: To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions.

Design: Single-blind randomized controlled trial of 2 types of gait exercises in older adults.

Setting: Research center in an academic institution.

Aging, motor skill, and the energy cost of walking: implications for the prevention and treatment of mobility decline in older persons.

Background: Age-associated neural changes profoundly affect the biomechanics and energetics of walking, increase energy cost, and require novel approaches to exercise that focus on motor learning theory.

Methods: We present a conceptual framework for motor skill in walking, its effect on the energy cost of walking, and the influence of the aging brain.

Results: Motor learning theory and practice can be incorporated into interventions to promote skilled, energy efficient walking in older people.

The Test-Retest Reliability of Indirect Calorimetry Measures of Energy Expenditure During Overground Walking in Older Adults With Mobility Limitations.

The purpose of this study was to assess the relative and absolute reliability of metabolic measures of energy expenditure and gait speed during overground walking in older adults with mobility limitations. Thirty-three (mean age [SD] = 76.4 [6.

Motor learning versus standard walking exercise in older adults with subclinical gait dysfunction: a randomized clinical trial.

Objectives: To compare the effect of motor learning with that of standard exercise on measures of mobility and perceived function and disability.

Design: Single-blind randomized trial.

Setting: University research center.

White matter hyperintensities, exercise, and improvement in gait speed: does type of gait rehabilitation matter?

Objectives: To examine whether white matter hyperintensities (WMHs) on brain magnetic resonance imaging (MRI) in tracts in older adults with mobility impairment are linked to outcomes of gait rehabilitation interventions.

Design: Twelve-week randomized controlled single-blind trial.

Setting: University-based mobility research laboratory.