Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Functional status and depressive symptoms among older adults from residential care facilities in the Czech Republic. Health-related quality of life in older adults at risk for disability. Validity of an exercise test based on habitual gait speed in mobility-limited older adults. Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Home-based resistance training: predictors of participation and adherence. Body weight dynamics and their association with physical function and mortality in older adults: the Cardiovascular Health Study. Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial Association of visual impairment with mobility and physical function. Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512). Efficacy of whey protein supplementation on resistance exercise-induced changes in lean mass, muscle strength, and physical function in mobility-limited older adults. Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Patient‐centred physical therapy is (cost‐) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow‐up Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility The effect of Tai Chi Chuan in reducing falls among elderly people: design of a randomized clinical trial in the Netherlands [ISRCTN98840266] Which impairments are most associated with high mobility performance in older adults? Implications for a rehabilitation prescription. Physical activity in prefrail older adults: confidence and satisfaction related to physical function. Home-Based Exercise Supported by General Practitioner Practices: Ineffective in a Sample of Chronically Ill, Mobility-Limited Older Adults (the HOMEfit Randomized Controlled Trial). Comparative effects of light or heavy resistance power training for improving lower extremity power and physical performance in mobility-limited older adults. What is a Clinically Meaningful Improvement in Leg-Extensor Power for Mobility-limited Older Adults?
IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 BACKGROUND in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs . OBJECTIVE to examine whether  tiredness in daily activities  is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women . DESIGN a prospect i ve study with 1 1/2-year follow-up . SETTING 34 communities in four counties in Denmark . SUBJECTS 1396 older non-disabled adults ( 74 - 75 and 80 years old ) living in 17 of the participating communities . METHODS question naire surveys at baseline and at 1 1/2-year follow-up . Tiredness in daily activities  was measured by questions about tiredness in six mobility activities . Onset of mobility disability was measured as onset of need for help in one to six mobility activities . RESULTS men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up , when adjusted by the covariates . In addition , low social participation , poor psychological function , and physical inactivity were independent risk factors of onset of mobility disability among men , and home help , low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women . CONCLUSION older people who complain about tiredness are at higher risk of becoming disabled than others . This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 BACKGROUND Depressive symptoms are common among older adults , particularly those living in long-term care facilities . However , little is known about factors associated with depressive symptoms among long-term care residents in the Czech Republic and in other Eastern European countries . Moreover , the role of mobility and pain in depressive symptoms among long-term care residents is relatively understudied . OBJECTIVE We examined the relationship between functional status and depressive symptoms in 308 older adults from residential care facilities ( RCFs ) in the Czech Republic . METHOD We used baseline data from two r and omized controlled trials testing the effects of dance and reminiscence therapies on quality of life in older RCF residents .  Functional status was measured as cognitive function , general ability to perform basic Activities of Daily Living ( ADLs ) , mobility , and functional limitation by pain . Depressive symptoms were measured using the 15-item Geriatric Depression Scale . RESULTS In multiple regression analyses adjusted for sociodemographic factors and taking antidepressants , we found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms . The ability to perform basic ADLs and mobility were also related to depressive symptoms . CONCLUSION Our findings suggest factors that may be important in efforts to improve psychological well-being in this population BACKGROUND The number of older adults living in the United States continues to increase , and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability . The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study . METHODS The Lifestyle Interventions and Independence for Elders-Pilot study ( LIFE-P ) was a r and omized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability . Baseline data ( collected in April-December 2004 , analyzed in 2006 ) included demographics , medical history , the Quality of Well-Being Scale ( QWB-SA ) , a timed 400-m walk , and the Short Physical Performance Battery ( SPPB ) . Descriptive health-related quality of life ( HRQOL ) data are presented . Hierarchical linear regression models were used to examine correlates of HRQOL . RESULTS The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 ( death ) to 1.0 ( asymptomatic , optimal functioning ) . The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults . The variables associated with lower HRQOL included white ethnicity , more comorbid conditions , slower 400-m walk times , and lower SPPB balance and chair st and scores . CONCLUSIONS Older adults who are at risk for disability had reduced HRQOL . Surprisingly , however , mobility was a stronger correlate of HRQOL than an index of comorbidity , suggesting that interventions addressing mobility limitations may provide significant health benefits to this population OBJECTIVE To evaluate whether a customized exercise tolerance testing ( ETT ) protocol based on an individual 's habitual gait speed ( HGS ) on level ground would be a valid mode of exercise testing older adults . Although ETT provides a useful means to risk-stratify adults , age-related declines in gait speed paradoxically limit the utility of st and ard ETT protocol s for evaluating older adults . A customized ETT protocol may be a useful alternative to these st and ard methods , and this study hypothesized that this alternative approach would be valid . DESIGN We performed a cross-sectional analysis of baseline data from a r and omized controlled trial of older adults with observed mobility problems . Screening was performed using a treadmill-based ETT protocol customized for each individual 's HGS . We determined the content validity by assessing the results of the ETTs , and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly ( PASE ) and the Late Life Function and Disability Instrument ( LLFDI ) . SETTING Outpatient rehabilitation center . PARTICIPANTS Community-dwelling , mobility-limited older adults ( N=141 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Cardiac instability , ETT duration , peak heart rate , peak systolic blood pressure , PASE , and LLFDI . RESULTS Acute cardiac instability was identified in 4 of the participants who underwent ETT . The remaining participants ( n=137 , 68 % female ; mean age , 75.3 y ) were included in the subsequent analyses . Mean exercise duration was 9.39 minutes , with no significant differences in duration s being observed after evaluating among tertiles by HGS status . Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/min and 175.0 mmHg , respectively . Within separate multivariate models ,  ETT duration in each of the 3 gait speed groups was significantly associated ( P<.05 ) with PASE and LLFDI . CONCLUSIONS Mobility-limited older adults can complete this customized ETT protocol , allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters OBJECTIVE To evaluate , in terms of function and mobility , the predictive value of commonly adopted anthropometric ' definitions ' used in the nutritional assessment of older adults , in a cohort of older Australians . DESIGN Prospect i ve cohort study - Australian Longitudinal Study of Ageing ( ALSA ) . SETTING Adelaide , South Australia ( 1992 - 1994 ) . SUBJECTS Data were analysed from 1272 non-institutionalised ( 685 males , 587 females ) older adults > or = 70 years old in South Australia . Seven ' definitions ' commonly used in the anthropometric assessment of both under- and overnutrition ( including four using body mass index ( BMI ) , waist-to-hip ratio , waist circumference and percentage weight change ) were evaluated at baseline , for their ability to predict functional and mobility limitation assessed ( by self-report question naire ) at two years follow-up . All question naires were administered and anthropometry performed by trained investigators . The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression . RESULTS A BMI > 85th percentile or > 30 kg m-2 or a waist circumference of > 102 cm in males and > 88 cm in females increased risk of functional and mobility limitations . Over two years , a loss of 10 % body weight significantly increased the risk of functional and mobility limitations . CONCLUSION Maintaining weight within older adults , irrespective of initial body weight , may be important in preventing functional and mobility limitations . Excessive weight is associated with an increased risk of limitation in function and mobility , both key components of health-related quality of life This study identified factors associated with exercise participation  and  adherence  in a sample of 102 sedentary , functionally limited , community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program .  Stepwise regression analyses revealed that baseline physical factors ( i.e. , higher levels of mobility , weaker muscle strength , and fewer numbers of new medical conditions ) were associated with higher rates of participation in the home program .  Positive attitudes and a sense of control toward exercise , lower levels of confusion and depressive moods , and the development of fewer new medical problems during the program were related to higher levels of adherence to the program . Findings revealed that although physical health variables were the primary indicators of an older person 's overall participation in the program , it was the psychological factors that were most important to adherence to this home-based program BACKGROUND To estimate the associations of weight dynamics with physical functioning and mortality in older adults . METHODS Longitudinal cohort study using prospect ively collected data on weight , physical function , and health status in four U.S. Communities in the Cardiovascular Health Study . Included were 3,278 participants ( 2,013 women and 541 African Americans ) , aged 65 or older at enrollment , who had at least five weight measurements . Weight was measured at annual clinic visits between 1992 and 1999 , and summary measures of mean weight , coefficient of variation , average annual weight change , and episodes of loss and gain ( cycling )  were calculated . Participants were followed from 1999 to 2006 for activities of daily living ( ADL ) difficulty , incident mobility limitations , and mortality . RESULTS Higher mean weight , weight variability , and weight cycling increased the risk of new onset of ADL difficulties and mobility limitations . After adjustment for risk factors , the hazard ratio ( 95 % confidence interval ) for weight cycling for incident ADL impairment was 1.28 ( 1.12 , 1.47 ) , similar to that for several comorbidities in our model , including cancer and diabetes . Lower weight , weight loss , higher variability , and weight cycling were all risk factors for mortality , after adjustment for demographic risk factors , height , self-report health status , and comorbidities . CONCLUSIONS Variations in weight are important indicators of future physical limitations and mortality in the elderly and may reflect difficulties in maintaining homeostasis throughout older ages . Monitoring the weight of an older person for fluctuations or episodes of both loss and gain is an important aspect of geriatric care Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors Background Definitive evidence that exercise interventions that improve gait also reduce disability is lacking . A task-oriented , motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed , but whether the intervention also improves activity and participation has not been demonstrated . Objective The objective of this study was to compare the impact of a task-oriented , motor sequence learning exercise ( TO ) intervention and the impact of an impairment-oriented , multicomponent exercise ( IO ) intervention on activity and participation outcomes in older adults with mobility limitations . The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined . Design This study was a single-blind , r and omized controlled trial . Setting The study was conducted in an ambulatory clinical research training center . Participants The study participants were 47 older adults ( mean age=77.2 years , SD=5.5 ) with slow and variable gait . Intervention The intervention was a 12-week , physical therapist – guided program of TO or IO . Measurements Measures of activity ( gait speed over an instrumented walkway ; daily physical activity measured with an accelerometer ; confidence in walking determined with the Gait Efficacy Scale ; and physical function determined with the total , basic lower-extremity , and advanced lower-extremity components of the Late-Life Function and Disability Instrument [ Late-Life FDI ] ) and participation ( disability limitation dimension and instrumental role [ home and community task performance ] domain components of the Late-Life FDI ) were recorded before and after the intervention . The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state st and ardized by walking speed . An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model , with baseline and change in energy cost of walking added to the model to test for mediation . Tests were used to determine the significance of the mediating effects . Results Activity improved in TO but not in IO for confidence in walking ( Gait Efficacy Scale ; mean adjusted difference=9.8 [ SD=3.5 ] ) and physical function ( Late-Life FDI basic lower-extremity component ; mean adjusted difference=3.5 [ SD=1.7 ] ) . Improvements in TO were marginally greater than those in IO for gait speed , physical activity , and total physical function . Participation improved marginally more in TO than in IO for disability limitations and instrumental role . Limitations The older adults were r and omized to the intervention group , but differences in baseline measures had to be accounted for in the analyses . Conclusions A TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations OBJECTIVE To examine the association of distant vision and physical function in the population of older adults . DESIGN Cross-sectional and cohort study . PARTICIPANTS 5143 older residents of three communities ( Established Population s for the Epidemiologic Studies of the Elderly ) who were interviewed in 1988 - 89 , including residents of two communities who were re-interviewed 15 months later ( n = 3133 , 97 % of those eligible ) . MEASURES  Visual acuity screening , self-reported activities of daily living and mobility , and objective physical performance measures of balance , walking , and rising from a chair .  RESULTS Limitations in mobility , activities of daily living , and physical performance were associated with worse visual function . In prospect i ve analyses controlling for potential confounders , participants with severe visual impairment had 3-fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better ( P < 0.001 ) . In prospect i ve analyses investigating the relationship of vision with improvement in function , those with poor vision were about half as likely to improve as those with better acuity , but this relationship was only statistically significant for improvement in mobility limitations . CONCLUSIONS Distant visual function appears to play an important role in physical function , particularly for mobility . An intervention to improve vision  in at-risk elders might preserve function and prevent disability ; this warrants further investigation The objective of this study is to describe the rationale , design and selected baseline results of a 2-year r and omized-controlled trial ( RCT ) on the effects of physical activity counseling in community-living older people . After a four-phase screening and data - collection process targeting all independently living people in the city center of Jyväskylä , Finl and , six hundred and thirty-two 75 - 81-year-old cognitively intact , sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were r and omized into intervention and control groups . At baseline , over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level . The desire to increase physical activity was more common ( 86 % ) among subjects with mobility limitation compared with those without ( 60 % , P=0.004 ) . The intervention group received an individualized face-to-face counseling session , followed by phone contacts every 3 months throughout the intervention . The study outcomes include physical activity level , mobility limitation , functional impairments , disability , mood , quality of life , use of services , institutionalization and mortality . The screening and recruitment process was feasible and succeeded well , and showed that unmet physical activity needs are common in older people BACKGROUND Whey protein supplementation may augment resistance exercise-induced increases in muscle strength and mass . Further studies are required to determine whether this effect extends to mobility-limited older adults . The objectives of the study were to compare the effects of whey protein concentrate ( WPC ) supplementation to an isocaloric control on changes in whole-body lean mass , mid-thigh muscle cross-sectional area , muscle strength , and stair-climbing performance in older mobility-limited adults in response to 6 months of resistance training ( RT ) . METHODS Eighty mobility-limited adults aged 70 - 85 years were r and omized to receive WPC ( 40g/day ) or an isocaloric control for 6 months . All participants also completed a progressive high-intensity RT intervention . Sample sizes were calculated based on the primary outcome of change in whole-body lean mass to give 80 % power for a 0.05-level , two-sided test . RESULTS Lean mass increased 1.3 % and 0.6 % in the WPC and control groups , respectively . Muscle cross-sectional area was increased 4.6 % and 2.9 % in the WPC and control groups , respectively , and muscle strength increased 16%-50 % in WPC and control groups . Stair-climbing performance also improved in both groups . However , there were no statistically significant differences in the change in any of these variables between groups . CONCLUSIONS These data suggest that WPC supplementation at this dose does not offer additional benefit to the effects of RT in mobility-limited older adults BACKGROUND Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes Abstract Background Despite the well‐known health benefits of physical activity , it is a great challenge to stay physically active for frail – older adults with mobility limitations . The aim of this study was to test the ( cost‐ ) effectiveness of a patient‐centred physical therapy strategy ( Coach2Move ) in which individualized treatment ( motivational interviewing , physical examination , individualized goal setting , coaching and advice on self management , and physical training ) is combined to increase physical activity level and physical fitness and , thereby , to decrease the level of frailty . Methods A r and omized controlled trial was performed in 13 physical therapy practice s with measurements at 3 and 6 months . Eligible patients were aged 70 years or over and had mobility problems ( i.e. difficulties with walking , moving , getting up and changing position from bed or chair to st and ing , or stair climbing ) . The primary outcome was physical activity ( total and moderate intensity ) in minutes per day . Secondary outcomes were as follows : frailty , walking speed and distance , mobility , and quality of life . Data were analysed using linear mixed models for repeated measurements . Healthcare costs and quality ‐adjusted life years ( QALYs ) were computed and combined using net monetary benefit ( NMB ) for different willingness to pay thresholds . Data on costs , QALYs , and NMBs were analysed using linear mixed models . Results One hundred and thirty patients participated in this study . At 6 months , the between‐group difference was significant for moderate‐intensity physical activity in favour of the Coach2Move group [ mean difference : 17.9 min per day ; 95 % confidence interval ( CI ) 4.0 to 34.9 ; P = 0.012 ] . The between‐group difference for total physical activity was 14.1 min per day ( 95 % CI −6.6 to 34.9 ; P = 0.182 ) . Frailty decreased more in the Coach2Move group compared with usual care [ mean difference : −0.03 ( 95 % CI : −0.06 to −0.00 ; P = 0.027 ) ] . Compared with usual treatment , the Coach2Move strategy result ed in cost savings ( € 849.8 ; 95 % CI : 1607 to 90 ; P = 0.028 ) , an improvement in QALYs , ( 0.02 ; 95 % CI : 0.00 to 0.03 ; P = 0.03 ) , and a higher NMB at every willingness to pay threshold . Conclusions Older adults with mobility problems are able to safely increase physical activity in their own environment and reduce frailty . This study emphasizes both the potential cost‐effectiveness of a patient‐centred approach in the frail elderly and the importance of physical activity promotion in older adults with mobility limitations BACKGROUND : Physical activity ( PA ) reduces the rate of mobility disability , compared with health education ( HE ) , in at risk older adults . It is important to underst and aspects of performance contributing to this benefit . OBJECTIVE : To evaluate intervention effects on tertiary physical performance outcomes . DESIGN : The Lifestyle Interventions and Independence for Elders ( LIFE ) was a multi‐centered , single‐blind r and omized trial of older adults . SETTING : Eight field centers throughout the United States . PARTICIPANTS : 1635 adults aged 78.9 ± 5.2 years , 67.2 % women at risk for mobility disability ( Short Physical Performance Battery [ SPPB ] < 10 ) . INTERVENTIONS : Moderate PA including walking , resistance and balance training compared with HE consisting of topics relevant to older adults . OUTCOMES : Grip strength , SPPB score and its components ( balance , 4 m gait speed , and chair‐st and s ) , as well as 400 m walking speed . RESULTS : Total SPPB score was higher in PA versus HE across all follow‐up times ( overall P = .04 ) as was the chair‐st and component ( overall P < .001 ) . No intervention effects were observed for balance ( overall P = .12 ) , 4 m gait speed ( overall P = .78 ) , or grip strength ( overall P = .62 ) . However , 400 m walking speed was faster in PA versus HE group ( overall P = < .001 ) . In separate models , 29 % of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score , while 39 % was explained by change in the chair st and component . CONCLUSION : Lower extremity performance ( SPPB ) was significantly higher in the PA compared with HE group . Changes in chair‐st and score explained a considerable portion of the effect of PA on the reduction of major mobility disability‐consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability Background Falls are a significant public health problem . Thirty to fifty percent of the elderly of 65 years and older fall each year . Falls are the most common type of accident in this age group and can result in fractures and subsequent disabilities , increased fear of falling , social isolation , decreased mobility , and even an increased mortality . Several forms of exercise have been associated with a reduced risk of falling and with a wide range of physiological as well as psychosocial health benefits . Tai Chi Chuan seems to be the most promising form of exercise in the elderly , but the evidence is still controversial . In this article the design of a r and omized clinical trial is presented . The trial evaluates the effect of Tai Chi Chuan on fall prevention and physical and psychological function in older adults . Methods / Design 270 people of seventy years and older living at home will be identified in the files of the participating general practitioners . People will be asked to participate when meeting the following inclusion criteria : have experienced a fall in the preceding year or suffer from two of the following risk factors : disturbed balance , mobility problems , dizziness , or the use of benzodiazepines or diuretics . People will be r and omly allocated to either the Tai Chi Chuan group ( 13 weeks , twice a week ) or the no treatment control group . The primary outcome measure is the number of new falls , measured with a diary . The secondary outcome measures are balance , fear of falling , blood pressure , heart rate , lung function parameters , physical activity , functional status , quality of life , mental health , use of walking devices , medication , use of health care services , adjustments to the house , severity of fall incidents and subsequent injuries . Process parameters will be measured to evaluate the Tai Chi Chuan intervention . A cost-effectiveness analysis will be carried out alongside the evaluation of the clinical results . Follow-up measurements will be collected at 3 , 6 and 12 months after r and omization . Discussion As far as we know this is the first trial in Europe considering Tai Chi Chuan and fall prevention . This project will answer a pragmatic research question regarding the efficacy of Tai Chi Chuan regarding fall reduction OBJECTIVE To test which rehabilitative impairments are associated with higher mobility performance among community-dwelling , mobility-limited older adults . DESIGN Cross-sectional analysis of baseline data from participants within a r and omized controlled trial . SETTING Outpatient rehabilitation research center . PARTICIPANTS Community-dwelling older adults ( N=138 ; mean age , 75.4 y ) with mobility limitations as defined by the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Balance measured via the Berg Balance Scale , leg strength , leg velocity , submaximal aerobic capacity , body mass index ( BMI ) , and mobility performance as measured by the SPPB . RESULTS Each of the 5 physiologic attributes ( unipedal balance , leg strength , leg velocity , submaximal aerobic capacity , BMI ) was categorized into tertiles by using lower values as reference for impairment status . Within an adjusted model , measures associated with higher SPPB performance ( > 9 ) included a BBS score greater than or equal to 54 ( odds ratio [OR]=4.54 ; 95 % confidence interval [ CI ] , 1.11 - 18.60 ) , leg strength greater than or equal to 21.5 N/kg ( OR=30.35 ; 95 % CI , 5.48 - 168.09 ) , leg velocity .0101 to .0129 m.s(-1).kg(-1 ) ( OR=5.31 ; 95 % CI , 1.25 - 22.57 ) , and leg velocity greater than or equal to .0130 m.s(-1).kg(-1 ) ( OR=22.86 ; 95 % CI , 3.88 - 134.75 ) . CONCLUSIONS Our investigation highlights the importance of rehabilitative impairments in leg strength , leg velocity , and balance as being associated with mobility status as measured by the SPPB . In our sample of participants within an exercise trial , submaximal aerobic capacity and BMI status were not associated with mobility performance . These findings suggest that the augmentation of not only leg strength and balance but also leg velocity may be important in the rehabilitative care of mobility-limited older adults We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70 + years of age who have deficits in mobility . We r and omized a total of 412 adults aged 70 - 89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months . Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention . Gender , age , and scores on a short physical performance battery did not moderate these effects . Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning . This is an important finding in light of the importance of these process variables in behavior change and quality of life OBJECTIVES To evaluate the effects a home-based exercise program delivered to ill and mobility-limited elderly individuals on physical function , physical activity , quality of life , fall-related self-efficacy , and exercise self-efficacy . DESIGN R and omized controlled trial ( IS RCT N Registry , Reg.-No . IS RCT N17727272 ) . SETTING Fifteen general practitioner ( GP ) practice s and participants ' homes . PARTICIPANTS Chronically ill and mobility-limited individuals aged 70 and older ( N = 209 ) . INTERVENTIONS An exercise therapist delivered the experimental intervention-a 12-week multidimensional home-based exercise program integrating behavioral strategies-in individual counseling sessions at the GPs ' practice s and over the telephone . The control intervention focused on promoting light-intensity activities of daily living . Interventions took place between February 2012 and March 2013 . MEASUREMENTS The primary outcome was functional lower body strength ( chair-rise test ) . Secondary outcomes were physical function ( battery of motor tests ) , physical activity ( step count ) , health-related quality of life ( Medical Outcomes Study 8-item Short-Form Survey ) , fall-related ( Falls Efficacy Scale-International Version ) , and exercise self-efficacy ( Selbstwirksamkeit zur sportlichen Aktivitaet ( SSA ) scale ) . Postintervention differences between the groups were tested using analysis of covariance ( intention to treat ; adjusted for baseline value and GP practice ; significance level P ≤ .05 ) . RESULTS Participants had a mean age ± st and ard deviation of 80 ± 5 , 74 % were female , 87 % had three or more chronic diseases , and 54 % used a walking aid . The difference ( intention to treat ; experimental minus control ) between adjusted postintervention chair-rise times was -0.1 ( 95 % confidence interval = -1.8 - 1.7 ) . Differences for all secondary outcomes were also nonsignificant . CONCLUSION The program was ineffective in the target population . Possibilities for improving the concept will have to be evaluated BACKGROUND We compared the effects of two uniquely different lower extremity power training interventions on changes in muscle power , physical performance , neuromuscular activation , and muscle cross sectional area in mobility-limited older adults . METHODS Fifty-two subjects ( 78±5 years , short physical performance battery score : 8.1±1 ) were r and omized to either 16 weeks of progressive high velocity resistance training performed at low external resistance ( 40 % of the 1-repetition maximum [ 1-RM ] [ LO ] ) or high external resistance ( 70 % of 1RM [ HI ] ) . Both groups completed three sets of leg and knee extension exercises at maximum voluntary velocity , two times per  week . Neuromuscular activation was assessed  using surface electromyography and muscle cross sectional area ( CSA ) was measured using computed tomography . RESULTS At 16 weeks , LO and HI exhibited significant and similar within-group increases of leg extensor peak power ( ~34 % vs ~42 % ) , strength ( ~13 % vs ~19 % ) , and SPPB score ( 1.4±0.3 vs 1.8±0.3 units ) , respectively ( all P < .03 ) . Improvements in neuromuscular activation occurred in LO ( P = .03 ) while small gains in mid-thigh muscle CSA were detected in LO ( 1.6 % , P = .35 ) and HI ( 2.1 % , P = .17 ) . No significant between-group differences were evident for any measured parameters ( all P > .25 ) . CONCLUSIONS High velocity resistance training with low external resistance yields similar improvements in muscle power and physical performance compared to training with high external resistance in mobility-limited elders . These findings may have important implication s for optimizing exercise interventions for older adults with mobility limitations BACKGROUND Muscle power is a key predictor of physical function in older adults ; however , clinical ly meaningful improvements in leg-extensor muscle power have yet to be identified . The purpose of this study is to establish the minimal clinical ly important improvement ( MCII ) and substantial improvement ( SI ) for leg-extensor power and muscle contraction velocity in mobility-limited older adults . METHODS Data were extracted from three r and omized trials of leg-extensor muscle power training interventions ( 3- to 6-month duration ) .  Measurements of leg-extensor power and velocity were obtained using dynamic bilateral leg press at 40 % and 70 % of the one-repetition maximum . Anchor-based MCIIs were calculated using selected items extracted from the Late Life Function and Disability Instrument . St and ard error of measurement and effect size methods were used to calculate the distribution-based MCII . RESULTS Data from 164 participants ( mean age : 76.6 ± 5.6 years ; Short Physical Performance Battery score : 7.8 ± 1.3 ) were used in this analysis . The respective MCII and SI estimates for 40 % leg-extensor power were 18.3 ( 9 % ) and 30.5 ( 15 % ) W , and 23.1 ( 10 % ) and 41.6 ( 18 % ) W for 70 % leg-extensor power . The respective MCII and SI estimates for 40 % average velocity were 0.03(7 % ) and 0.08(18 % ) m/s , and 0.02(6 % ) and 0.05(15 % ) m/s for 70 % average velocity . CONCLUSIONS This is the first study to establish a clinical ly meaningful improvement of leg-extensor power ( 9%-10 % ) and velocity ( 6%-7 % ) in mobility-limited older adults . These findings should be used to aid in the design and interpretation of clinical trials and interventions that target improvements in muscle power in this high-risk population
Several tools are available to assess mobility in the ambulatory setting .
Relatively few studies support therapeutic exercise to improve mobility limitation .
Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders .
Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function , safety , and quality of life for patients with mobility limitations
IMPORTANCE Mobility limitations are common in older adults , affecting the physical , psychological , and social aspects of an older adult 's life .
OBJECTIVE To identify mobility risk factors , screening tools , medical management , need for physical therapy  , and efficacy of exercise interventions for older primary care patients with limited mobility .