Motor Control-based Group Exercise: Can It be Delivered as Effectively by Lay Leaders?

Abstract

On the Move (OTM), a motor control-based group exercise program for community-dwelling older adults, has produced greater gains in mobility than a standard group exercise program when delivered by research leaders. The purposes of this study were:1) to examine the effectiveness of OTM versus a standard program when delivered by lay leaders and 2) to compare the outcomes of OTM when delivered by research versus lay leaders. Community-dwelling, medically stable older adults who could walk household distances participated. OTM consisted of warm-up, timing and coordination, strengthening, and stretching exercises. The seated standard program consisted of warm-up, aerobic, strengthening and stretching exercises. The primary outcome(s) of function and disability was the Late Life Function and Disability Instrument (LLFDI), and for walking ability were the Six Minute Walk Test and gait speed. 126 participants (mean age = 80.7±7.8 years, gait speed = 0.91 m/s) were randomized to OTM (n=49) or standard (n=77) programs. When taught by lay leaders, there were no significant between-intervention group differences in any of the outcomes (p>0.10). Comparing OTM outcomes between leaders, there was a statistical but not clinically meaningful difference in LLFDI disability (1.87±0.89, p=0.04) when taught by research versus lay leader, and moderate differences (p=0.06) in LLFDI overall function (1.89±1.02) and gait speed (0.05±0.03). Qualitative interview responses suggest that instructor-related concerns may have impacted program outcomes. When delivered by lay leaders OTM was not more effective than a standard program for improving function, disability, and mobility in older adults. Health promotion programs designed to improve mobility in community-dwelling older adults and based on a motor control theoretical background, may be best taught by rehabilitation professionals.