Walking Aids Moderate Exercise Effects on Gait Speed in People With Dementia: A Randomized Controlled Trial

Objectives: To investigate the effects of exercise on gait speed, when tested using walking aids and without, and whether effects differed according to amount of support in the test. Design: A cluster-randomized controlled trial. Setting: The Ume (a) over circle Dementia and Exercise (UMDEX) study was set in 16 nursing homes in Ume (a) over circle, Sweden. Participants: One hundred forty-one women and 45 men (mean age 85 years) with dementia, of whom 145 (78%) habitually used walking aids. Intervention: Participants were randomized to the high-intensity functional exercise program or a seated attention control activity. Measurements: Blinded assessors measured 4-m usual gait speed with walking aids if any gait speed (GS), and without walking aids and with minimum amount of support, at baseline, 4 months (on intervention completion), and 7 months. Results: Linear mixed models showed no between-group effect in either gait speed test at 4 or 7 months. In interaction analyses exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used. Positive between-group exercise effects on gait speed (m/s) were found in subgroups that walked unsupported at 4 and 7 months (GS: 0.07, P = .009 and 0.13, P < .001; and GS test without walking aids: 0.05, P = .011 and 0.07, P = .029, respectively). Conclusions: In people with dementia living in nursing homes exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used. The study suggests that the use of walking aids in gait speed tests may conceal exercise effects. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.