Brain-Focused Regime Is Better at Improving Gait

Abstract

WASHINGTON — An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, according to results of a controlled trial of the two approaches. Standard physical therapy to build strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, PhD, a physical therapist and rehabilitation specialist at the University of Pittsburgh. “There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.” Motor-learning exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Standard physical therapy for gait problems focuses on the hips, legs, knees, and ankles and includes exercises such as standing on one leg for balance. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention. The motor-learning group practiced walking patterns including ovals, spirals, serpentines, and more-challenging paths. The group also walked on a treadmill to increase speed. The study's primary outcome was energy spent walking, measured as the average rate of oxygen consumption during 3 minutes of walking on a treadmill at a self-selected speed. The researchers also tracked the participants' walking speeds and assessed their gaits. After 12 weeks, the 23 adults in the motor-learning group walked using significantly less energy than the 24 adults in the standard intervention group. Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. “Walking when it is most efficient is an integrated and highly coordinated function and skilled activity,” said Dr. Van Swearingen. “A slow and variable gait contributes to the energy cost of walking.” Although the study was limited by its small size and short duration, the success of both interventions was noteworthy. “We got changes from the relatively moderate intervention of twice a week,” Dr. Van Swearingen noted. She added that more research is needed to determine whether changes resulting from a motor-learning program can be maintained. Dr. Van Swearingen stated that she had no relevant financial conflict. Heidi Splete is a senior writer with Elsevier Global Medical News.