1. This cluster-randomized, single-blind intervention trial showed that the On the Move exercise program, a program focusing on timing and coordination of movement, was more effective in improving mobility than seated program focusing on strength, endurance, and flexibility in community-dwelling older adults
2. Group exercises to improve mobility in older adults should include timing and coordination exercises.
Evidence Rating Level: 2 (Good)
Study Rundown: While muscle strengthening is important for maintaining mobility in the elderly, bolstering timing and coordination may also be important in improving walking in older adults. This randomized intervention trial aimed to compare the effectiveness of the On the Move (OTM) group exercise program with a seated strength, endurance and flexibility program (usual care) at improving function, disability, and walking ability in older adults.
The OTM program was found to have greater mean improvements in gait speed and 6-minute walk distance. There was no difference in the self-reported Late Life Function and Disability Instrument (LLFDI) overall function and disability frequency domains. Strengths of this study included introduction and study of a new domain of exercise that may improve mobility in our community-dwelling geriatric population. However, this was a single-blind study, which may bias results towards the OTM program, also the study did not look at rate of falls, an important clinical outcome.
Relevant Reading: Interventions to Improve Walking in Older Adults
In-Depth [randomized study]: This cluster-randomized, single-blind intervention study was conducted from April 2014 to March 2016, and included 32 independent living facilities, senior apartment buildings and senior community centres. These centers were randomized to either the intervention of interest, the OTM program, or usual care. The OTM program consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening and stretching exercises. Usual care program included warm-up, strength, endurance and stretching exercises. Programs were 50 minutes, twice a week for 12 weeks. Attendance was also documented for comparison. Participants were 65 years or older, able to ambulate independently, had a gait speed of at least 0.6 m/s, able to follow two-step command and were medically stable. Outcomes of interest included LLFDI overall function and disability frequency domains, 6-minute walk distance and gait speed. Statistical analysis included intention-to-treat analysis and multivariable, linear mixed regression models.
Thirty-two sites were included in the study, 16 were randomized to OTM and 16 to usual care. Participants were mostly female and had a mean [SD] age of 80.0 [8.1] years. They had a mean [SD] of 2.8 [1.4] chronic conditions. Both groups were similar on baseline characteristics. The OTM program had greater mean [SD] improvements in gait speed (0.05 [0.13] vs. -0.01 [0.11] m/s; adjusted difference 0.05 [0.02] m/s; p = 0.002) and 6-minute walk distance (20.6 [57.1] vs. 4.1 [55.6] m; adjusted difference 16.7 [7.4] m; p = 0.03 as compared to usual care. Attendance was significantly different between the two groups with 76% attending more than 20 classes in the OTM group vs. 95% attending more than 20 classes in the usual care group.
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