Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
The KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
BMC Geriatr. 2024 Sep 6;24(1):740. doi: 10.1186/s12877-024-05331-4.
We estimated the short-term effects of an educational workshop and 10-week outdoor walk group (OWG) compared to the workshop and 10 weekly reminders (WR) on increasing outdoor walking (primary outcome) and walking capacity, health-promoting behavior, and successful aging defined by engagement in meaningful activities and well-being (secondary outcomes) in older adults with difficulty walking outdoors.
In a 4-site, parallel-group randomized controlled trial, two cohorts of community-living older adults (≥ 65 years) reporting difficulty walking outdoors participated. Following a 1-day workshop, participants were stratified and randomized to a 10-week OWG in parks or 10 telephone WR reinforcing workshop content. Masked evaluations occurred at 0, 3, and 5.5 months. We modeled minutes walked outdoors (derived from accelerometry and global positioning system data) using zero-inflated negative binomial regression with log link function, imputing for missing observations. We modeled non-imputed composite measures of walking capacity, health-promoting behavior, and successful aging using generalized linear models with general estimating equations based on a normal distribution and an unstructured correlation matrix. Analyses were adjusted for site, participation on own or with a partner, and cohort.
We randomized 190 people to the OWG (n = 98) and WR interventions (n = 92). At 0, 3, and 5.5 months, median outdoor walking minutes was 22.56, 13.04, and 0 in the OWG, and 24.00, 26.07, and 0 in the WR group, respectively. There was no difference between groups in change from baseline in minutes walked outdoors based on incidence rate ratio (IRR) and 95% confidence interval (CI) at 3 months (IRR = 0.74, 95% CI 0.47, 1.14) and 5.5 months (IRR = 0.77, 95% CI 0.44, 1.34). Greater 0 to 3-month change in walking capacity was observed in the OWG compared to the WR group (βz-scored difference = 0.14, 95% CI 0.02, 0.26) driven by significant improvement in walking self-efficacy; other comparisons were not significant.
A group, park-based OWG was not superior to WR in increasing outdoor walking activity, health-promoting behavior or successful aging in older adults with difficulty walking outdoors; however, the OWG was superior to telephone WR in improving walking capacity through an increase in walking self-efficacy. Community implementation of the OWG is discussed.
ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.
我们评估了一个教育研讨会和为期 10 周的户外步行小组（OWG）与研讨会和每周 10 次提醒（WR）对增加户外步行（主要结果）和步行能力、促进健康行为以及成功老龄化的短期影响，成功老龄化的定义是参与有意义的活动和幸福感（次要结果）在有困难的老年人中户外行走。
在一个 4 个地点的平行组随机对照试验中，两个队列的社区居住的老年人（≥65 岁）报告了户外行走困难。在为期 1 天的研讨会之后，参与者被分层并随机分配到为期 10 周的公园 OWG 或 10 次电话 WR，以加强研讨会内容。在 0、3 和 5.5 个月时进行了盲法评估。我们使用零膨胀负二项回归模型和对数链接函数来建模户外行走的分钟数（通过加速度计和全球定位系统数据得出），对缺失的观察值进行插补。我们使用基于正态分布和非结构化相关矩阵的广义线性模型来对步行能力、促进健康行为和成功老龄化的非插补综合指标进行建模。分析根据地点、自行或与伴侣参与以及队列进行了调整。
我们将 190 人随机分配到 OWG（n=98）和 WR 干预组（n=92）。在 0、3 和 5.5 个月时，OWG 组的户外行走分钟中位数分别为 22.56、13.04 和 0，WR 组分别为 24.00、26.07 和 0。基于发生率比（IRR）和 95%置信区间（CI），3 个月（IRR=0.74，95%CI 0.47，1.14）和 5.5 个月（IRR=0.77，95%CI 0.44，1.34）时，两组之间的户外行走分钟数从基线的变化无差异。与 WR 组相比，OWG 组的步行能力在 0 到 3 个月之间的变化更大（βz 评分差异=0.14，95%CI 0.02，0.26），这是由于行走自我效能感显著提高所致；其他比较则无显著差异。
在有困难的户外行走的老年人中，基于公园的 OWG 组与 WR 组相比，在增加户外活动、促进健康行为或成功老龄化方面并没有优势；然而，OWG 组在改善步行能力方面优于电话 WR 组，这是通过提高步行自我效能感实现的。还讨论了 OWG 在社区中的实施情况。
ClinicalTrials.gov NCT03292510 注册日期：2017 年 9 月 25 日。
