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 .
Preclinical mobility disability predicts incident mobility disability in older women.
BACKGROUND Physical disability and dependency are serious , and frequent , adverse health outcomes associated with aging and result ing from chronic disease . Reasoning has suggested that there might be a pre clinical , intermediate phase of disablement which might develop in parallel with progression of underlying disease and precede and predict disability . Definition of this stage could provide a basis for screening and early intervention to prevent disability . The objective of this study was to determine pre clinical functional predictors of incident mobility difficulty and provide evidence for a pre clinical stage of disability . METHODS A prospect i ve , population -based cohort study was carried out in Baltimore , Maryl and , with two evaluations 18 months apart . The participants were 436 community-dwelling women , 70 - 80 years of age at baseline , not cognitively impaired , and reporting difficulty in no areas , or only one area , of physical function ( primarily mobility ) , who were participating in the Women 's Health and Aging Study II . Participants were recruited from a population -based , age-stratified r and om sample .  Incident mobility disability was studied in the subset without such disability at baseline . The main outcome measure was self-reported incident difficulty walking 1/2 mile or climbing up 10 steps . RESULTS At baseline , 69.3 % of the cohort reported no difficulty with mobility . After 18 months , 16.0 and 11.7 % of this group reported incident difficulty walking 1/2 mile or climbing up 10 steps , respectively . Those reporting baseline task modification due to underlying health problems , our measure of pre clinical disability , were at three- to fourfold higher odds of progressing to difficulty than were those without such modification . In multivariate logistic regression analyses , this self-report measure , task modification without difficulty , and objective measures of performance were independently and jointly predictive of incident mobility difficulty . Specifically , for incident difficulty walking 1/2 mile , self-reported task modification odds ratio ( OR ) = 3.67 , walking speed ( .5 m/s difference ) OR = 2.16 ; for incident difficulty climbing up 10 stairs , OR for task modification = 3.84 , for stair climb speed ( 1/3 step/s difference ) = 2.08 ( 95 % CI did not include 1 for any ) . Covariates , age , living alone , number of chronic diseases , depression score , knee strength , and balance by functional reach , were not significant predictors in either model . CONCLUSIONS Two indicators of functional changes in older women without mobility difficulty , self-report of modification of method of doing a task in the absence of difficulty and performance measures , are independent and strong predictors of risk of incident mobility disability . The self-report measure provides substantial strength in predicting risk of incident disability across the full range of performance , and may identify a vulnerable point at which other risk factors act to cause transitions to disability . Together , the pre clinical indicators identify a subset of high-functioning older women who are at high risk of mobility disability , and provide a potential basis for screening for disability risk and targeting interventions to prevent mobility disability
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 .