Abstract
BackgroundHabitual walking speed predicts many clinical conditions later in life, but it declines with age. However, which particular exercise intervention can minimize the age-related gait speed loss is unclear.PurposeOur objective was to determine the effects of strength, power, coordination, and multimodal exercise training on healthy old adults’ habitual and fast gait speed.MethodsWe performed a computerized systematic literature search in PubMed and Web of Knowledge from January 1984 up to December 2014. Search terms included ‘Resistance training’, ‘power training’, ‘coordination training’, ‘multimodal training’, and ‘gait speed (outcome term). Inclusion criteria were articles available in full text, publication period over past 30 years, human species, journal articles, clinical trials, randomized controlled trials, English as publication language, and subject age ≥65 years. The methodological quality of all eligible intervention studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. We computed weighted average standardized mean differences of the intervention-induced adaptations in gait speed using a random-effects model and tested for overall and individual intervention effects relative to no-exercise controls.ResultsA total of 42 studies (mean PEDro score of 5.0 ± 1.2) were included in the analyses (2495 healthy old adults; age 74.2 years [64.4–82.7]; body mass 69.9 ± 4.9 kg, height 1.64 ± 0.05 m, body mass index 26.4 ± 1.9 kg/m2, and gait speed 1.22 ± 0.18 m/s). The search identified only one power training study, therefore the subsequent analyses focused only on the effects of resistance, coordination, and multimodal training on gait speed. The three types of intervention improved gait speed in the three experimental groups combined (n = 1297) by 0.10 m/s (±0.12) or 8.4 % (±9.7), with a large effect size (ES) of 0.84. Resistance (24 studies; n = 613; 0.11 m/s; 9.3 %; ES: 0.84), coordination (eight studies, n = 198; 0.09 m/s; 7.6 %; ES: 0.76), and multimodal training (19 studies; n = 486; 0.09 m/s; 8.4 %, ES: 0.86) increased gait speed statistically and similarly.ConclusionsCommonly used exercise interventions can functionally and clinically increase habitual and fast gait speed and help slow the loss of gait speed or delay its onset.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-015-0371-2) contains supplementary material, which is available to authorized users.
Highlights
Habitual walking speed measured on a level surface predicts many conditions later in life, including daily function [38, 39], mobility [40, 41], independence [42], falls [19, 43, 44], fear of falls [45], fractures [43], health [46], mental health [47], cognitive function [48,49,50,51], post-acute transition to the community [52], adverse clinical events [53], hospitalization [38], institutionalization [42], mortality [53,54,55], and survival [56, 57]
Even healthy old compared with young adults present with substantial reductions in muscle strength [70], muscle power [71, 72], muscle mass [73], incomplete muscle activation [66], sensory dysfunction [74], balance problems [33], coordination deficits [16], and sub-clinical cognitive [48] and mobility impairments, i.e., slow gait [12], we argue that these dysfunctions are evenly and randomly distributed among healthy old adults
We identified ten studies that examined the effects of exercise interventions on the TUG in 304 and 268 healthy old adults in the experimental and control group, respectively
Summary
Bipedal locomotion is a hallmark of human evolution, and gait speed affords evolutionary [1], medical [2,3,4,5], cognitive [6, 7], and health-related [8, 9] benefits to humans across the lifespan, especially to the aged [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]. Habitual walking speed measured on a level surface predicts many conditions later in life, including daily function [38, 39], mobility [40, 41], independence [42], falls [19, 43, 44], fear of falls [45], fractures [43], health [46], mental health [47], cognitive function [48,49,50,51], post-acute transition to the community [52], adverse clinical events [53], hospitalization [38], institutionalization [42], mortality [53,54,55], and survival [56, 57] (for a review, see Abellan van Kan et al [10]). A strong consensus is emerging that family physicians should incorporate walking speed in clinical practice as a standard measurement of old adults’ daily function and mobility [4, 60]. Electronic supplementary material The online version of this article (doi:10.1007/s40279-015-0371-2) contains supplementary material, which is available to authorized users
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