Original articleImproving Motor Control in Walking: A Randomized Clinical Trial in Older Adults With Subclinical Walking Difficulty
Section snippets
Overview
The study protocol was approved by the University of Pittsburgh Institutional Review Board, and all subjects provided informed consent. The study was registered at ClinicalTrials.gov (PRO09080228). The Program to Improve Mobility in the Elderly (PRIME study) was a 12-week, single-blind randomized clinical trial that compared 2 exercise interventions in older adults with subclinical gait dysfunction. Details of the methods and the main study outcomes have been published elsewhere.7
Participants and inclusion criteria
Briefly, the
Results
Of 110 people initially screened by telephone, 64 underwent on-site screening. Forty-one participants met all criteria, and 40 were randomized (1 subject deferred); 38 of these individuals completed the study.7 All 38 completers participated in at least 22 exercise sessions, with 37 participants (97%) completing all 24 sessions. The 2 dropouts developed unrelated medical conditions and walked more slowly than those who completed the study. Participants had a mean age of 77.1 years, near-normal
Discussion
Older adults with normal gait speed and subclinical gait deficits who participated in a task-oriented motor learning exercise program demonstrated greater improvements in some indicators of the motor control of walking than those who participated in a standard impairment-based exercise program. Individuals in the motor learning program had greater improvements in 1 measure of gait variability (double-support time variability) and smoothness of walking (HRAP and HRV during narrow and dual-task
Conclusions
Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.
Suppliers
- a.
SAS Institute Inc.
- b.
Magnum Fitness Systems.
- c.
EQ, Inc.
- d.
BIOPAC Systems, Inc.
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2023, Archives of Physical Medicine and RehabilitationProgram to improve mobility in aging (PRIMA) study: Methods and rationale of a task-oriented motor learning exercise program
2020, Contemporary Clinical TrialsCitation Excerpt :Conceptually, the exercise is intended to achieve its effects by shifting the center of pressure posterior-lateral then forward, encouraging hip extension prior to stepping, loading the trailing limb, coordinating activation of the abductors of the soon to be swing leg with adductors of the stance limb, and shifting the center of pressure in medial stance to unload the stepping limb. Progression is based on first separately increasing the speed, amplitude or accuracy of performance prior to undertaking a more complex task [12,13,18,20]. For example, the progression of stepping patterns is, 1) self-paced step forward and across, 2) increase stepping speed, 3) alternate side of stepping, and 4) alternate forward with backward stepping.
The reliability and validity of the Figure of 8 Walk test in older people with knee replacement: does the setting have an impact?
2019, Physiotherapy (United Kingdom)Citation Excerpt :By only reporting time to complete the F8W, essential higher level aspects of gait in an elderly population may have been overlooked with undue emphasis placed on cognitive processing speed and less on overall stability and susceptibility to falling. Thus inclusion of the accuracy component of the F8W may be more important for populations with more frailty and may have clinical relevance particularly in identifying subtle problems with performance, for example during dual activities where the additional challenge of balancing speed with accuracy may bring out performance deficits [27]. To reduce the burden and time commitment for study participant’s different groups of participants were assessed either at home or in clinic.
Spatiotemporal variability underlying skill in curved-path walking
2019, Gait and PostureEnergy Impairments in Older Adults With Low Back Pain and Radiculopathy: A Matched Case-Control Study
2018, Archives of Physical Medicine and RehabilitationCitation Excerpt :However, mobility deficits often persist even after pain is effectively managed. Fortunately, prior work has shown that there are effective rehabilitation strategies, such as exercises that focus on the timing and coordination of walking, that improve the energy efficiency of walking among older adults.24 Second, clinicians should consider optimizing chronic disease management to help reduce, or prevent rise in, the energy cost of walking.
Supported by the Pittsburgh Older Americans Independence Center (grant no. NIA P30 AG024827) and the Beeson Career Development Award (grant no. NIA K23 AG026766).
Clinical Trials Registration No.: PRO09080228.
Disclosures: S.P. reports grants from InRange Systems, Inc, during the conduct of the study. The other authors have nothing to disclose.