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- Title
Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial.
- Authors
Brach, Jennifer S.; Perera, Subashan; Shuman, Valerie; Gil, Alexandra B.; Kriska, Andrea; Nadkarni, Neelesh K.; Rockette-Wagner, Bonny; Cham, Rakie; VanSwearingen, Jessie M.
- Abstract
Key Points: Question: What is the effect of adding timing and coordination training to a standard strength and endurance program on mobility in community-dwelling older adults? Findings: In this randomized clinical trial that included 249 older adults, treatment with either the standard program or the program enhanced with timing and coordination training resulted in improved gait speed. There was no difference between groups. Meaning: These findings suggest that timing and coordination training may not yield additional benefit compared with a standard program to improve walking among older adults. This randomized clinical trial examines whether the addition of timing and coordination training to a standard exercise program for strength and endurance improved walking among community-dwelling older adults more than strength and endurance training alone. 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. Design, Setting, and Participants: The Program to Improve Mobility in Aging (PRIMA) study was an assessor-blinded, randomized, 2-group intervention trial that included a 12-week intervention and 24-week follow-up period. The trial was conducted at a university research clinic from 2016 to 2020. Participants included 249 community-dwelling older adults (aged ≥65 years) with gait speed between 0.60 and 1.20 m/s. Statistical analysis was performed from December 2020 to March 2021. Interventions: Participants were randomized to standard strength and endurance (n = 125) or standard-plus, including timing and coordination training (n = 124), 50 to 60 minutes, twice a week for 12 weeks. Main Outcomes and Measures: Primary outcome of gait speed and secondary outcomes representing components of the intervention (leg strength and power, 6-minute walk test, chair sit-and-reach test, and figure of 8 walk test) and activity and participation (Late Life Function and Disability Instrument and daily physical activity measured by accelerometry) were measured at 12, 24, and 36 weeks. Results: Among 249 randomized participants, 163 (65.5%) were female, 22 (8.8%) were Black, 219 (88.0%) were White; mean (SD) age was 77.4 (6.6) years; mean (SD) gait speed was 1.07 (0.16) m/s; and 244 (98.0%) completed the intervention. The 2 groups did not have significantly different improvements in gait speed or secondary outcomes representing the components of the intervention at any time point. For gait speed, individuals in the standard-plus group had a mean (SD) improvement of 0.079 (0.135) m/s over 12 weeks, 0.065 m/s (0.141) over 24 weeks, and 0.059 (0.150) m/s over 36 weeks; individuals in the standard group improved gait speed by 0.081 (0.124) m/s over 12 weeks, 0.051 (0.129) m/s over 24 weeks, and 0.065 (0.148) m/s over 36 weeks. Conclusions and Relevance: This randomized clinical trial found no difference in gait speed change between the standard and standard-plus intervention groups, and both groups showed sustained improvements in mobility 24 weeks after the intervention. Trial Registration: ClinicalTrials.gov Identifier: NCT02663778
- Subjects
WALKING speed; ENDURANCE sports training; TIME; EXERCISE physiology; STRENGTH training; PHYSICAL activity; RANDOMIZED controlled trials; ACCELEROMETRY; PHYSICAL mobility; INDEPENDENT living; MOBILITY training; RESEARCH funding; OLD age
- Publication
JAMA Network Open, 2022, Vol 5, Issue 5, pe2212921
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.12921