Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2022 May 2;5(5):e2212921. doi: 10.1001/jamanetworkopen.2022.12921.
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.
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.
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.
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.
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.
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.
ClinicalTrials.gov Identifier: NCT02663778.
针对潜在生理系统损伤的标准运动干预在改善步行能力方面收效甚微。通过定时和协调训练来增强标准干预，该训练结合了运动学习的原则并整合了多个系统，可能会更有效。
确定纳入定时和协调训练的标准力量和耐力计划（标准加）是否比单纯的力量和耐力训练更能提高步行速度。
设计、地点和参与者：改善老龄化人群移动能力计划（PRIMA）研究是一项评估者盲法、随机、2 组干预试验，包括 12 周的干预和 24 周的随访期。该试验在 2016 年至 2020 年在一所大学研究诊所进行。参与者包括 249 名社区居住的老年人（年龄≥65 岁），步行速度在 0.60 至 1.20 米/秒之间。统计分析于 2020 年 12 月至 2021 年 3 月进行。
参与者被随机分配至标准力量和耐力组（n = 125）或标准加组，包括定时和协调训练（n = 124），每周两次，每次 50 至 60 分钟，共 12 周。
主要结果是步行速度，次要结果代表干预的组成部分（腿部力量和力量、6 分钟步行测试、坐立前伸测试和 8 字形步行测试）以及活动和参与（晚年功能和残疾量表和通过加速度计测量的日常体力活动）在 12、24 和 36 周时进行测量。
在 249 名随机参与者中，163 名（65.5%）为女性，22 名（8.8%）为黑人，219 名（88.0%）为白人；平均（SD）年龄为 77.4（6.6）岁；平均（SD）步行速度为 1.07（0.16）米/秒；244 名（98.0%）完成了干预。两组在任何时间点的步行速度或代表干预组成部分的次要结果均无显著差异。对于步行速度，标准加组在 12 周内平均（SD）提高了 0.079（0.135）米/秒，在 24 周内提高了 0.065 米/秒（0.141），在 36 周内提高了 0.059（0.150）米/秒；标准组在 12 周内提高了 0.081（0.124）米/秒，在 24 周内提高了 0.051（0.129）米/秒，在 36 周内提高了 0.065（0.148）米/秒。
这项随机临床试验发现标准和标准加干预组之间在步行速度变化方面没有差异，并且两组在干预后 24 周都持续改善了移动能力。
ClinicalTrials.gov 标识符：NCT02663778。
