A Randomized Trial of Two Forms of Therapeutic Activity to Improve Walking: Effect on the Energy Cost of Walking

Background. Therapeutic activities to improve mobility often include walking practice and exercises to improve deficits in endurance, strength. and balance. Because walking may also be energy inefficient in people with decreased mobility, another approach is to reduce energy cost by improving timing and coordination (TC) of movement. Methods. This pilot randomized trial of older adults with slow and variable gait offered two types of therapeutic activity over 12 weeks. One addressed Walking, Endurance, Balance, and Strength (WEBS) and the other focused on TC. Outcomes were energy cost of walking and measures of mobility. Results. Of 50 participants (mean age. 77.2 +/- 5.5 years, 65% women). 47 completed the study. Baseline gait speed was 0.85 +/- 0.13 m/s and energy cost of walking was 0.30 +/- 0.10 mL/kg/m, nearly twice normal. Both interventions increased gait speed (TC by 0.21 m/s and WEBS by 0.14 m/s, p < .001). TC reduced the energy cost of walking 0.10 +/- 0.03 mL/kg/m more than WEBS (p < .001) and reduced the modified Gait Abnormalities Rating Scale 1.5 +/- 0.6 more points than WEBS (p < .05). TC had a 9.8 +/- 3.5 points greater gain than WEBS in self-reported confidence in walking (p < .01). Conclusions. In older adults with slow and variable gait, activity focused on TC reduced the energy cost of walking and improved confidence in walking more than WEBS while generating at least equivalent gains in mobility. To optimize mobility, future larger studies should assess various combinations of TC and WEBS over longer periods of time.