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

Interventions to improve outdoor mobility among people living with disabilities: A systematic review

Background

Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization.

Objectives

To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components.

Search Methods

Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries.

Selection Criteria

Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility.

Data Collection and Analysis

Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence.

Main Results

The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions.

Authors’ Conclusions

Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.

The Impact of a 12-Week Aqua Fitness Program on the Physical Fitness of Women over 60 Years of Age

BACKGROUND

This study aimed to assess the impact of a 12-week Aqua Fitness program on the physical fitness of older women and emphasize sustainable health practices for aging populations. We focused on evaluating the program's effectiveness, using the Senior Fitness Test to measure improvements in physical capabilities.

METHODS

An experimental research design was implemented, with 30 participants aged 60 and older. The participants were divided into a control group and an experimental group, each comprising 15 individuals. The control group received aqua Fitness exercises, and the experimental group received aqua fitness exercises and isometric (combined) exercises. Lower limb muscle strength, upper limb muscle strength, lower body flexibility, upper body flexibility, dynamic balance, agility, and endurance were assessed using the Senior Fitness Test. Assessments were conducted pre- and post-training.

RESULTS

For a comparison within the group, combined exercises (aqua fitness and isometric exercises) had a significant effect on lower limb muscle strength, upper limb muscle strength, lower body flexibility, upper body flexibility on the right side, dynamic balance, agility, and endurance. Aqua fitness exercises alone showed significant effects on upper limb muscle strength, lower body flexibility, and endurance and no significant effects on other variables. For the comparison between groups, no significant differences were found between the effects of aqua fitness exercises and combined exercises on lower limb muscle strength, upper limb muscle strength, lower body flexibility, upper body flexibility, and endurance. Significant differences were found only in dynamic balance and agility between the two groups of aqua fitness and combined exercises.

CONCLUSIONS

Although the combined program (aqua fitness and isometric exercises) had a greater effect on improving the physical fitness of older adults than aqua fitness alone, there was no significant difference between the two groups. Therefore, the results of this study highlight the potential of aqua fitness in promoting sustainable health and physical fitness in the older adult population.

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). PFC activation was measured by functional near-infrared spectroscopy (fNIRS) during four walking tasks over 15 m, each repeated 4 times: even surface walking, uneven surface walking, even dual-task, uneven dual-task; dual-task was reciting every other letter of the alphabet while walking. Gait speed and rate of correct letter generation were recorded. Linear mixed models tested between arm differences in change of fNIRS, gait speed, and letter generation from baseline to follow-up (12-week, 24-week, and 36-week).

RESULTS

Intervention arms were similar in mean age (74.3 vs. 77.0) and baseline gait speed (0.96 vs. 0.93 m/s). Of 24 comparisons of between arm differences in the fNIRS signals, only two were significant which were not supported by differences at other follow-up times or on other tasks. Gait speed, particularly during dual-task conditions, and correct letter generation did improve post-intervention but improvements did not differ by arm.

DISCUSSION AND CONCLUSIONS

After training, PFC activation during walking generally did not improve and did not differ by intervention arm. Improvements in gait speed without increased PFC activation may point toward more efficient neural control of walking.

Global Positioning System Indicators of Community Mobility and Future Health Outcomes Among Older Adults

BACKGROUND

We examined the relationship between global positioning system (GPS) indicators of community mobility and incident hospitalizations, emergency department (ED) visits, and falls over 1-year in community-dwelling older adults.

METHODS

We performed a secondary analysis of a randomized trial investigating a physical therapy intervention to improve mobility in older adults. One hundred and forty-eight participants (mean age: 76.9 ± 6.2 years; 65% female) carried a GPS device following the postintervention visit. Over 1-year, new hospitalizations, falls, and ED visits were reported. GPS indicators of community mobility included the median area and compactness of the standard deviation ellipse (SDE), the median percentage of time spent outside of home (TOH), and median maximum distance from home. Generalized linear models assessed the association between 1-year risk of outcomes and GPS measures adjusted for age, race, gender, body mass index, comorbidity burden, and fall history.

RESULTS

The mean ± standard deviation of the median SDE area was 4.4 ± 8.5 km2, median SDE compactness 0.7 ± 0.2, median percentage TOH 14.4 ± 12.0%, and median maximum distance from home was 38 ± 253 km. Each 5% increase in median percentage TOH was associated with a 24% lower risk of hospitalization (incident rate ratio = IRR = 0.76, 95%CI: 0.61-0.95; p = .01). The association persisted after covariate adjustment (IRR = 0.78, 95%CI: 0.63-0.98; p = .03). No significant associations appeared for any GPS indicators with incident falls or ED visits.

CONCLUSIONS

Increased TOH was associated with a lower risk of incident hospitalization over 1 year among community-dwelling older adults. Restricted community mobility may be an indicator of activity limitations related to future health outcomes, but further study is warranted.

Exercise interventions, postural control, and prefrontal cortex activation in older adults

Improving postural control in older adults is necessary for reducing fall risk, and prefrontal cortex activation may also play a role. We sought to examine the impact of exercise interventions on postural control and prefrontal cortex activation during standing balance tasks. We hypothesized that balance would improve and prefrontal control would be reduced. We assessed a subset of participants enrolled in a randomized trial of two exercise interventions. Both groups completed strength and endurance training and the experimental treatment arm included training on timing and coordination of stepping. Postural control and prefrontal cortex activation were measured during dual-task standing balance tasks before and after the intervention. Eighteen participants in the standard strengthening and mobility training arm and 16 in the timing and coordination training arm were included. We examined pre- to post-intervention changes within each study arm, and compared them between interventions. Results did not show any pre- to post-intervention changes on standing postural control nor prefrontal cortex activation in either arm. In addition, there were no differences between the two intervention arms in either balance or prefrontal activation. While exercise interventions can improve mobility, we do not demonstrate evidence of improved standing balance or prefrontal control in standing.

Prediction models of grip strength in adults above 65 years using Korean National Physical Fitness Award Data from 2009 to 2019

PURPOSE

We aimed to determine the best machine learning (ML) regression model for predicting grip strength in adults above 65 years using various independent variables, such as body composition, blood pressure, and physical performance.

METHODS

The data comprised 107,290 participants, of whom 33.3% were male and 66.7% were female in Korean National Fitness Award Data from 2009 to 2019. The dependent variable was grip strength, which was calculated as the mean of right and left grip strength values.

RESULTS

The results showed that the CatBoost Regressor had the lowest mean squared error (M [Formula: see text] SE:16.659 ± 0.549) and highest R2 value (M [Formula: see text] SE:0.719 ± 0.009) among the seven prediction models tested. The importance of independent variables in facilitating model learning was also determined, with the Figure-of-8 walk test being the most significant. These findings suggest that walking ability and grip strength are closely related, and the Figure-of- 8 walk test is a reasonable indicator of grip strength in older adults.

CONCLUSION

The findings of this study can be used to develop more accurate predictive models of grip strength in older adults.

Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial.

METHODS

Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis.

RESULTS

There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same.

CONCLUSION

There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation.

IMPACT

The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.