Task Specific Timing and Coordination Exercises to Improve Mobility in Older Adults

描述（由申请人提供）：行走困难在老年人中是常见且昂贵的。虽然传统的锻炼已被证明可以促进身心健康，并可能预防行走困难，但这种锻炼侧重于力量和耐力，而忽视了行走能力的一个关键组成部分；动作的时机和协调衰老和疾病改变了时间和协调，这反映在神经运动表现减慢、步态变异性增加和运动平稳性降低上。任务特定的时间和协调练习，包括在多种步行条件下平稳协调的步态方面的练习，比标准程序更有可能提高步行能力。我们的初步数据表明，对步态的时间和协调的干预比标准的力量和耐力计划对活动能力的影响更大。下一个关键步骤和本建议的目标是将这两种干预措施结合起来，以确定从标准加上时间和协调方案中获得的流动性、活动和参与的潜在收益是否大于单独从标准方案中获得的收益。因此，拟议项目的主要目的是评估在标准力量和耐力训练中增加时间和协调训练对活动能力的影响。次要目标包括检查1)代表干预组成部分的额外结果以及活动和参与的措施，2)干预的延迟和持续效果，以及3)干预在各种其他感兴趣的亚组中的效果。这项随机临床试验对行走缓慢（即< 1.20米/秒）的老年人进行了372

DESCRIPTION (provided by applicant): Walking difficulty is common and costly in older adults. While traditional exercise has been shown to promote physical and mental health and may prevent walking difficulty, such exercise has focused on strength and endurance, and has overlooked a critical component of walking ability; the timing and coordination of movement. Aging and disease alter timing and coordination as reflected by slowed neuromotor performance, increased gait variability and reduced smoothness of movement. Task specific timing and coordination exercise that includes practice of smooth coordinated aspects of gait over multiple walking conditions has the potential to improve walking ability greater than a standard program. Our preliminary data suggest that interventions on timing and coordination of gait impact mobility greater than the standard strength and endurance program. The next key step and the objective of this proposal is to combine the two interventions to determine if potential gains in mobility, activity and participation obtained from a standard plus timing and coordination program, are larger than the gains obtained from the standard program alone. Therefore, the primary aim of the proposed project is to evaluate the impact of adding timing and coordination training to standard strength and endurance training on mobility. Secondary aims include examining 1) additional outcomes representing the components of the intervention and measures of activity and participation, 2) the delayed and sustained effects of the intervention, and 3) the effects of the intervention within various other subgroups of interest. This randomized clinical trial in older adults who walk slowly (i.e. < 1.20 m/s) will compare a 372 community-dwelling non-intervention attention control and a standard 12 week strength, endurance and flexibility program to a 12 week "standard- plus" program of strength, endurance, flexibility plus task specific timing and coordination training. The primary outcome is gait speed at 12 weeks. We will also examine secondary and tertiary outcomes representing components of the intervention and measures of activity and participation and the delayed and sustained effects at 24 and 36 weeks. The findings from this efficacy trial will provide evidence for the added value of task specific timing and coordination training for promoting walking ability in older adults and will form the basis for future effectiveness trials. Future work includes translation to nonprofessional exercise leaders with the long-term goal to incorporate neurological training into standard exercise programs for health promotion for older adults.