The Effect of High Intensity Walking on Frailty

项目总结 脆弱影响高达60%的老年人，是老年人依赖的主要原因。脆弱 老年人会出现身体问题，如平衡困难、虚弱、耐力下降和 步行速度减慢会增加摔倒、住院、住院和死亡的风险。物理 活动具有多系统的健康益处，是最受推荐的脆弱管理干预措施，但 关于体力活动的具体强度的指导方针仍然不清楚。高强度的体力活动 在其他人群中建立了安全的治疗方法，但尚不清楚在多大程度上 高强度的运动可以减少或扭转虚弱。这项随机分组的研究将比较高强度的 步行(HIW)干预到实施的自选随意快速步行(CSW)干预 为体弱前和体弱的老年人设立的退休社区。我们将随机选择10个退休社区和20个 每个地点的参与者(总共200名参与者)接受为期4个月的HIW或CSW干预。所有参与者 将在退休期间接受48次单独监督的地面步行训练 社区。在研究开始和结束时，我们将测量参与者的脆弱程度、活动能力、身体状况 通过佩戴1周的ActialPAL加速度计测量功能、平衡和总的体力活动 观察期，比较HIW和CSW哪种治疗策略在降低虚弱方面效果更好(目标1)。 我们将使用Share-Frailty工具来评估脆弱性，作为一种类别(例如，非脆弱、预脆弱或 脆弱)和持续的结果。这种方法将允许我们确定参与者如何在 脆弱类别以及在脆弱类别内对干预的反应。在目标2中，我们将确定 步行强度对活动、身体功能、平衡和总体力活动的影响。我们假设 HIW参与者将表现出更低的虚弱和更好的行动能力、身体功能、平衡和 4个月时进行体力活动。目前，身体虚弱的老年人的最佳体力活动指南是 不确定。这项研究的结果将为老年人的活动指南提供重要的知识 与脆弱性和有关降低脆弱性、改善功能和提高 在越来越多的老年人口中进行体育活动。

PROJECT SUMMARY Frailty impacts up to 60% of older adults and is a leading cause of dependency among older adults. Frail older adults experience physical problems such as balance difficulties, weakness, decreased endurance, and reduced walking speed that increase risk for falls, hospitalizations, institutionalization, and death. Physical activity has multi-system health benefits and is the most recommended frailty management intervention, but guidelines regarding the specific intensity of physical activity remain unclear. High intensity physical activity is an established and safe therapeutic approach in other populations, but it is unclear as to the extent to which high intensity activity can reduce or reverse frailty. This cluster-randomized study will compare a high intensity walking (HIW) intervention to a self-selected, casual speed walking (CSW) intervention implemented within retirement communities for pre-frail and frail older adults. We will randomize 10 retirement communities with 20 participants at each site (200 total participants) to either a 4-month HIW or CSW intervention. All participants will receive 48, individually supervised overground walking sessions occurring within their retirement community. At the beginning and end of the study, we will measure participants’ frailty, mobility, physical functioning, balance, and total physical activity measured via an ActivPal accelerometer worn for a 1-week observation period to compare which treatment strategy, HIW or CSW, worked better to reduce frailty (aim #1). We will use the SHARE-Frailty Instrument to evaluate frailty as both a categorical (e.g. non-frail, pre-frail, or frail) and a continuous outcome. This approach will allow us to determine how participants move between frailty categories as well as within frailty categories in response to intervention. In aim #2, we will determine the effect of walking intensity on mobility, physical functioning, balance, and total physical activity. We hypothesize that HIW participants will show decreased frailty and improved mobility, physical functioning, balance, and physical activity at 4 months. Currently, the optimal physical activity guidelines for older adults with frailty are uncertain. Results from this study will provide important knowledge to inform activity guidelines for older adults with frailty and information on a transformative approach to reducing frailty, improving function, and increasing physical activity among a growing segment of the older adults population.