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.

Adapting and Evaluating the Feasibility and Acceptability of a Behavioral Intervention to Promote Sleep Health in Cardiac Rehabilitation.

Objectives: Study objectives were to: 1) iteratively adapt the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for patients in cardiac rehabilitation (CR; Phase 1) and 2) conduct a preliminary single group pre-post intervention test to a) evaluate procedural feasibility and intervention acceptability and b) to explore preliminary pre-post changes in self-reported sleep, disability, and health-related quality of life (HRQoL; Phase 2).

Method: In Phase 1, 12 individuals in CR and six content experts completed interviews to inform TranS-C adaptations. Interviews were analyzed using rapid qualitative analysis.

Prefrontal cortex activation while walking did not change but gait speed improved after a randomized physical therapy intervention.

Background: Higher prefrontal cortex (PFC) activation while walking may indicate reduced gait automaticity.

Aim: We examine whether PFC activation during walking improves after training in older adults at risk for mobility disability.

Methods: Forty-two adults aged ≥ 65 participated in a randomized clinical trial (NCT026637780) of a 12-week timing and coordination physical therapy intervention to improve walking (n = 20 intervention, n = 22 active control).

Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals.

Background: Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications.

Objective: In this cross-sectional study, we examined the relationships between FOF and gait quality.

Methods: Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question.

Uneven surface and cognitive dual-task independently affect gait quality in older adults.

Background: Real-world mobility involves walking in challenging conditions. Assessing gait during simultaneous physical and cognitive challenges provides insights on cognitive health.

Research Question: How does uneven surface, cognitive task, and their combination affect gait quality and does this gait performance relate to cognitive functioning?

Methods: Community-dwelling older adults (N = 104, age=75 ± 6 years, 60 % females) performed dual-task walking paradigms (even and uneven surface; with and without alphabeting cognitive task (ABC)) to mimic real-world demands.

Association of Gait Quality With Daily-Life Mobility: An Actigraphy and Global Positioning System Based Analysis in Older Adults.

Objective: Walking is a key component of daily-life mobility. We examined associations between laboratory-measured gait quality and daily-life mobility through Actigraphy and Global Positioning System (GPS). We also assessed the relationship between two modalities of daily-life mobility i.

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.

Academy of Geriatric Physical Therapy Research Agenda: Rationale for the Development and the Intent for Use.

The rationale for the development and the intent for use of a research agenda for the Academy of Geriatric Physical Therapy is described. The reasons for the research agenda for geriatric physical therapy are (1) to have a broad representation of the research conducted by physical therapist(s) working with older adults, (2) to provide guidance and assistance to emerging investigators to aid the trajectory of a research career, and (3) as a document to engage potential funding agencies, foundations, and individuals in support of physical therapist-conducted research. The design was based on the Research Agenda for Physical Therapy (APTA document), formatted to be consistent with the World Health Organization International Classification of Functioning, Disability and Health, priority ratings for the research statements, and specific examples of research questions for each category of the Research Agenda.

Facilitators and barriers to real-life mobility in community-dwelling older adults: a narrative review of accelerometry- and global positioning system-based studies.

Real-life mobility, also called "enacted" mobility, characterizes an individual's activity and participation in the community. Real-life mobility may be facilitated or hindered by a variety of factors, such as physical abilities, cognitive function, psychosocial aspects, and external environment characteristics. Advances in technology have allowed for objective quantification of real-life mobility using wearable sensors, specifically, accelerometry and global positioning systems (GPSs).

Mobility of Older Adults: Gait Quality Measures Are Associated With Life-Space Assessment Scores.

Background: The relation of gait quality to real-life mobility among older adults is poorly understood. This study examined the association between gait quality, consisting of step variability, smoothness, regularity, symmetry, and gait speed, and the Life-Space Assessment (LSA).

Method: In community-dwelling older adults (N = 232, age 77.

Acceleration Gait Measures as Proxies for Motor Skill of Walking: A Narrative Review.

In adults 65 years or older, falls or other neuromotor dysfunctions are often framed as walking-related declines in motor skill; the frequent occurrence of such decline in walking-related motor skill motivates the need for an improved understanding of the motor skill of walking. Simple gait measurements, such as speed, do not provide adequate information about the quality of the body motion's translation during walking. Gait measures from accelerometers can enrich measurements of walking and motor performance.

Assessing gait efficacy in older adults: An analysis using item response theory.

Background: Assessing confidence in walking in older adults is important, as mobility is a critical aspect of independence and function, and self-report provides complementary information to performance-based measures. The modified Gait Efficacy Scale (mGES) is a self-report measure used to examine confidence in walking.

Research Question: What are the psychometric properties of the mGES at the item level? Are there opportunities for improvement?

Methods: We performed a secondary analysis of baseline data from a cluster randomized trial of 424 community-dwelling older adults and reliability data from 123 participants.

Development and Validation of Person-Centered Cut-Points for the Figure-of-8-Walk Test of Mobility in Community-Dwelling Older Adults.

Background: The Figure-of-8-Walk test (F8WT) is a performance measure of the motor skill of walking. Unlike walking speed over a straight path, it captures curved path walking, which is essential to real-world activity, but meaningful cut-points have yet to be developed for the F8WT.

Methods: A secondary analysis of 421 community-dwelling older adults (mean age 80.

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.

Effect of Community-Based Group Exercise Interventions on Standing Balance and Strength in Independent Living Older Adults.

Background And Purpose: Many interventions to improve mobility in older adults often include exercises to address underlying impairments such as strength deficits. Task-oriented exercise interventions that focus more on walking and stepping tasks that may be encountered in the community have been considered for improving mobility in older adults. The main purpose was to examine the effect of task-oriented and impairment-based group exercise interventions on standing balance and lower extremity muscle strength.

Phonation Demonstrates Goal Dependence Under Unique Vocal Intensity and Aerobic Workload Conditions.

Purpose This study investigated whether metabolic respiratory requirements (treadmill workload) affected glottal valving in phonation, based on aerodynamic measures, when a sound pressure level (vocal SPL) is dictated as a target goal. Consistent with a theory of action, we hypothesized that adjustments in glottal valving as measured by laryngeal airway resistance would be dependent upon vocal SPL level, even as workload increased, and loud vocal SPL would interfere more with respiratory homeostasis than spontaneous vocal SPL. Method Thirty-two women enrolled who were ages 18-35 years.

An observational treatment-based gait pattern classification method for targeting interventions for older adult males with mobility problems: Validity based on movement control and biomechanical factors.

Background: A reliable and valid observational gait assessment intended to guide clinical intervention for gait deficits in older adults has not been proposed. A quick gait classification method which tailors clinical management for different patterns of gait dysfunction may be useful for clinicians with limited access to apply computer-assisted gait analyses.

Research Question: This work aims to establish reliability and validity of the Treatment-Based Gait Pattern Classification (TBGPC) that can be used to quickly identify and classify mobility problems of older males, and possibly target interventions for specific gait deficits in clinical settings.

Intraclass Correlation Coefficients for Planning Cluster Randomized Trials in Community-Dwelling Older Adults.

With the emerging trends, more cluster randomized trials will be conducted in older adults, where facilities are randomized rather than individuals. Similarity of individuals from a facility (intraclass correlation coefficient/ICC) plays a critical role, but not readily available. We document ICCs for measures commonly used in community-dwelling older adults and discuss implications.

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.

Spatiotemporal variability underlying skill in curved-path walking.

Background: Daily life walking frequently involves curved paths. While mean gait characteristics and orientation of the body during curved path walking have been described, little has been reported about spatiotemporal variability during curved path walking and its relation to the motor skill of walking in older adults.

Research Question: Among community-dwelling older adults, is greater spatiotemporal variability during curved path walking related to better curved path walking ability?

Methods: Community dwelling older adults (n = 34) completed the Figure-of-8 Walk Test (F8W, a measure of curved path walking ability) and usual straight path walking on an instrumented walkway.

Motor Control-based Group Exercise: Can It be Delivered as Effectively by Lay Leaders?

Purpose: On the Move (OTM), a motor control-based group exercise program for community-dwelling older adults, has produced greater gains in mobility than a standard group exercise program when delivered by research leaders. The purposes of this study were:1) to examine the effectiveness of OTM versus a standard program when delivered by lay leaders and 2) to compare the outcomes of OTM when delivered by research versus lay leaders.

Methods: Community-dwelling, medically stable older adults who could walk household distances participated.

"You can tell by the way I use my walk." Predicting the presence of cognitive load with gait measurements.

Background: There is considerable evidence that a person's gait is affected by cognitive load. Research in this field has implications for understanding the relationship between motor control and neurological conditions in aging and clinical populations. Accordingly, this pilot study evaluates the cognitive load based on gait accelerometry measurements of the walking patterns of ten healthy individuals (18-35 years old).

The Study of Laryngoscopic and Autonomic Patterns in Exercise-Induced Laryngeal Obstruction.

Objectives: (1) Identify laryngeal patterns axiomatic to exercise-induced laryngeal obstruction (EILO) and (2) investigate the role of autonomic function in EILO.

Methods: Twenty-seven athletic adolescents (13 EILO, 14 control) underwent laryngoscopy at rest and exercise. Glottal configurations, supraglottic dynamics, systolic blood pressure responses, and heart rate recovery were compared between conditions and groups.