Brach Jennifer S, Perera Subashan, Gilmore Sandra, VanSwearingen Jessie M, Brodine Deborah, Nadkarni Neelesh K, Ricci Edmund
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Intern Med. 2017 Oct 1;177(10):1437-1444. doi: 10.1001/jamainternmed.2017.3609.
Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults.
To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults.
DESIGN, SETTING, AND PARTICIPANTS: Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable.
Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises.
The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals.
Participants (mean [SD] age, 80.0 [8.1] years) were mostly female (251 [84.2%]) and white (249 [83.6%]) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 [0.13] vs -0.01 [0.11] m/s; adjusted difference = 0.05 [0.02] m/s; P = .002) and 6-minute walk distance (20.6 [57.1] vs 4.1 [55.6] m; adjusted difference = 16.7 [7.4] m; P = .03). Attendance was greater in the usual-care program compared with On the Move (95 [65.1%] vs 76 [50.0%] attended ≥20 classes; P = .03). There were no significant differences in any of the other primary or secondary outcomes.
The On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice.
clinicaltrials.gov Identifier: NCT01986647.
计时与协调性练习可能是社区健康促进锻炼计划的一项重要补充内容，有助于改善老年人的行走能力。
比较侧重于运动计时与协调性的“动起来”团体锻炼计划与一项坐姿力量、耐力及柔韧性计划（常规护理）在改善老年人功能、残疾状况及行走能力方面的效果。
设计、设置与参与者：整群随机单盲干预试验。32个独立生活设施、老年公寓楼及老年社区中心被随机分为“动起来”组（16个场所；152名参与者）或常规护理组（16个场所；146名参与者）。参与者年龄在65岁及以上，能够以至少0.60米/秒的步速独立行走，能够听从两步指令，且医学状况稳定。
锻炼课程时长50分钟，每周两次，共12周，且每班参与者不超过10人。“动起来”计划包括热身、计时与协调性（迈步及行走模式）、强化及伸展练习。常规护理计划包括热身、力量、耐力及伸展练习。
主要结局为功能与残疾状况的自我报告（晚年功能与残疾量表）以及由盲法评估人员评估的活动能力（6分钟步行距离及步速）。
参与者（平均[标准差]年龄为80.0[8.1]岁）大多为女性（251人[84.2%]）且为白人（249人[83.6%]），平均（标准差）患有2.8（1.4）种慢性病。干预组在基线特征方面相似。干预后，“动起来”组的142名（93.4%）参与者及常规护理组的139名（95.2%）参与者完成了测试。“动起来”组在步速（0.05[0.13]米/秒对 -0.01[0.11]米/秒；调整后差异 = 0.05[0.02]米/秒；P = .002）和6分钟步行距离（20.6[57.1]米对4.1[55.6]米；调整后差异 = 16.7[7.
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