Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?

Abstract

The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6‑month follow-up and to determine which factors are associated with these changes. This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3years; 73.5% female) at risk of falling who exercised either in agroup (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6‑month follow-up were analyzed, including calculation of effect sizes (Cohen'sd). Determinants of changes in the walking episodes were analyzed using multiple regression. The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6months. Parameters of objective and subjective function explained avery small but significant amount of the variance. The LiFE program seems to work on abehavioral rather than on afunctional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).