Article

Definitive evidence that exercise interventions that improve gait
also reduce disability is lacking. A task-oriented, motor sequence learning
exercise intervention has been shown to reduce the energy cost of walking and
improve gait speed, but whether the intervention also improves activity and
participation has not been demonstrated. The objective of this study
was to compare the impact of a task-oriented, motor sequence learning exercise
(TO) intervention and the impact of an impairment-oriented, multicomponent
exercise (IO) intervention on activity and participation outcomes in older adults
with mobility limitations. The mediating effects of a change in the energy cost
of walking on changes in activity and participation also were determined. DESIGN:
This study was a single-blind, randomized controlled trial. Setting The study was
conducted in an ambulatory clinical research training center. PARTICIPANTS: The
study participants were 47 older adults (mean age=77.2 years, SD=5.5) with slow
and variable gait. Intervention The intervention was a 12-week, physical
therapist-guided program of TO or IO. MEASUREMENTS: Measures of activity (gait
speed over an instrumented walkway; daily physical activity measured with an
accelerometer; confidence in walking determined with the Gait Efficacy Scale; and
physical function determined with the total, basic lower-extremity, and advanced
lower-extremity components of the Late-Life Function and Disability Instrument
[Late-Life FDI]) and participation (disability limitation dimension and
instrumental role [home and community task performance] domain components of the
Late-Life FDI) were recorded before and after the intervention. The energy cost
of walking was determined from the rate of oxygen consumption during self-paced
treadmill walking at the physiological steady state standardized by walking
speed. An adjusted comparison of activity and participation outcomes in the
treatment arms was made by use of an analysis of covariance model, with baseline
and change in energy cost of walking added to the model to test for mediation.
Tests were used to determine the significance of the mediating effects. RESULTS:
Activity improved in TO but not in IO for confidence in walking (Gait Efficacy
Scale; mean adjusted difference=9.8 [SD=3.5]) and physical function (Late-Life
FDI basic lower-extremity component; mean adjusted difference=3.5 [SD=1.7]).
Improvements in TO were marginally greater than those in IO for gait speed,
physical activity, and total physical function. Participation improved marginally
more in TO than in IO for disability limitations and instrumental role.
LIMITATIONS: The older adults were randomized to the intervention group, but
differences in baseline measures had to be accounted for in the analyses.
CONCLUSIONS: A TO intervention that improved gait also led to improvements in
some activity and participation outcomes in older adults with mobility
limitations.

Langue : ANGLAIS