title: Predicting the risk of mobility difficulty in older women with screening nomograms: the Women's Health and Aging Study II. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. Should physical activity programs be tailored when older adults have compromised function? Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Health-related quality of life in older adults at risk for disability. Diabetes mellitus and incidence of lower body disability among older Mexican Americans. Lower extremity power training in elderly subjects with mobility limitations: a randomized controlled trial Current status and correlates of physicians' referral diagnoses for physical therapy. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Moderate exercise improves gait stability in disabled elders. Measuring life-space mobility in community-dwelling older adults. Weighted stair climbing in mobility-limited older people: a pilot study. Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. The effects of physical therapists' guidance on improvement in a strength-training program for the frail elderly. Joint effects of adiposity and physical activity on incident mobility limitation in older adults. Group exercise can improve participants' mobility in an outpatient rehabilitation setting: a randomized controlled trial Sit-to-stand as home exercise for mobility-limited adults over 80 years of age--GrandStand System may keep you standing? Preclinical mobility disability predicts incident mobility disability in older women. Effects of an Interactive Computer Game Exercise Regimen on Balance Impairment in Frail Community-Dwelling Older Adults: A Randomized Controlled Trial Impact of Exercise to Improve Gait Efficiency on Activity and Participation in Older Adults With Mobility Limitations: A Randomized Controlled Trial Risk Factors and Precipitants of Long-Term Disability in Community Mobility
abstract: BACKGROUND A major obstacle to screening for early mobility disability ( ie , mobility difficulty ) , a major public health concern , is the lack of a method that identifies those who are at high risk . The goal of this study was to develop easy-to-use clinical nomograms for estimation of the probability of incident mobility difficulty . METHODS We conducted a population -based prospect i ve study using data from 266 high physically and cognitively functioning older women , aged 70 to 80 years , who were free of mobility disability at the baseline evaluation of the Women 's Health and Aging Study II . The outcome measure was incident mobility disability within 18 months , defined as self-reported difficulty walking 0.8 km , climbing 10 steps , or transferring from or into a car or bus . Logistic regression and receiver operating characteristic curve analyses were used for evaluation of the optimal combination of self-reported and performance-based mobility measures . Bootstrap sampling and estimation was used for validation . RESULTS Predictive nomograms were developed based on a final model that included 3 simple-to-obtain measures of pre clinical disability : self-report of modification in mobility tasks without having difficulty with them , one-leg stance balance , and time to walk 1 m at a usual pace . Final model accuracy ( as estimated by the area under the receiver operating characteristic curve ) was 73 % ( SE = 0.04 ) . Validation analysis confirmed the high accuracy of these nomograms . CONCLUSIONS An original tool was developed for assessment of the risk of mobility difficulty in older women that can be used to assist physicians and research ers in deciding which women to target for preventive interventions OBJECTIVES To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems . DESIGN Prospect i ve , single-blind , r and omized , controlled trial . SETTING District general hospital . PARTICIPANTS One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale ( BBS ) score of less than 45 . INTERVENTIONS Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance . The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems .  MEASUREMENTS Ten-meter timed walk test ( TWT ) , BBS , Frenchay Activities Index ( FAI ) , Falls H and icap Inventory ( FHI ) , and European Quality of Life question naire ( Euroqol ) measured at 6 , 12 , and 24 weeks after intervention . RESULTS The mean age + /- st and ard deviation of subjects was 82.7 + /- 5.6 , and baseline characteristics were comparable between the groups . Both groups showed improvements in TWT ( intervention : 22.5 - 16.5 seconds , P = .001 ; control : 20.5 - 15.8 seconds , P = .054 ) , BBS ( intervention : 33.3 - 42.7 , P = .001 ; control : 33.4 - 42.0 , P < .0001 ) , FAI ( 18 - 21 , P = .02 in both groups ) , FHI score ( intervention : 31 - 17 , P = .0001 ; control : 33 - 17 , P = .0001 ) and Euroqol score ( intervention : 58 - 65 , P = .04 ; control : 60 - 65 , P = .07 ) . There were no intergroup differences at any time . More patients reported increased confidence in walking indoors ( 36 % vs 28 % ; P = .04 ) and outdoors ( 27 % vs 18 % ; P = .02 ) in the enhanced balance-training group . CONCLUSION Exercise programs significantly improve balance and mobility in patients with balance problems , independent of strategy . Enhanced balance training may , in addition , improve confidence and quality of life but needs further investigation The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation OBJECTIVES To vali date self-reported pre clinical mobility limitation concept and self-report assessment method against muscle power and walking speed , and to study the predictive validity of pre clinical mobility limitation with respect to future risk of manifest mobility limitation . DESIGN Observational prospect i ve cohort study and cross-sectional analysis . SETTING Research laboratory and community . PARTICIPANTS A total of 632 community-living ( age range , 75 - 81 y ) women and men took part in the baseline assessment s and 302 persons in the semi-annual interviews on mobility limitation over 2 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Walking speed , muscle power , and self-reported pre clinical and manifest mobility limitation . Pre clinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty . At baseline , 4 subgroups were created according to self-reported pre clinical mobility limitation in any of 3 mobility tasks ( walking 2 km , walking 0.5 km , climbing up stairs ) : no limitation , pre clinical limitation , and minor and major manifest limitation . RESULTS At baseline , participants with pre clinical mobility limitation showed intermediate levels of walking speed and muscle power , compared with those with no limitation or manifest mobility limitation . Participants reporting baseline pre clinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline , whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation . CONCLUSIONS The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability 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 BACKGROUND Little is known about the effect of diabetes mellitus on subsequent lower body disability in older Mexican Americans , one of the fastest growing ethnic groups in the United States . The aim of this study is to examine the relationship between diabetes mellitus and incident lower body disability over a 7-year follow-up period . METHODS Ours was a 7-year prospect i ve cohort study of 1835 Mexican-American individuals > or = 65 years old , nondisabled at baseline , and residing in five Southwestern states . Measures included self-reported physician diagnosis of diabetes , stroke , heart attack , hip fracture , arthritis , or cancer . Disability measures  included  activities of daily living ( ADLs ) , mobility tasks , and an 8-foot walk test . Body mass index , depressive symptoms , and vision function  were also measured . RESULTS At 7-year follow-up , 48.7 % of diabetic participants nondisabled at baseline developed limitations in one or more measures of lower body function . Cox proportional regression analyses showed that diabetic participants were more likely to report any limitation in lower body ADL function ( hazard ratio [ HR ] = 2.05 , 95 % confidence interval [ CI ] , 1.58 - 2.67 ) , mobility tasks ( HR = 1.69 , 95 % CI , 1.39 - 2.04 ) , and 8-foot walk ( HR = 1.46 , 95 % CI , 1.15 - 1.85 ) compared with nondiabetic participants , after controlling for relevant factors . Older age and having one or more diabetic complications were significantly associated with increased risk of limitations in any lower body ADL and mobility task at follow-up . CONCLUSION Older Mexican Americans with diabetes mellitus are at high risk for development of lower body disability over time . Awareness of disability as a potentially modifiable complication and use of interventions to reduce disability should become health priorities for older Mexican Americans with diabetes Background and aims : This study investigated whether high-velocity high-power training ( POW )  improved lower extremity muscle power and quality in functionally-limited elders greater than traditional slow-velocity progressive resistance training ( STR ) . Methods : Fifty-seven community-dwelling older adults aged 74.2±7 ( range 65–94 yrs ) , Short Physical Performance Battery score 7.7±1.4 , were r and omized to either POW ( n=23 ) ( 12 females ) , STR ( n=22 ) ( 13 females ) or a control group of lower extremity stretching ( CON ) ( n=12 ) ( 6 females ) . Training was performed three times per week for 12 weeks and subjects completed three sets of double leg press and knee extension exercises at 70 % of the one repetition maximum ( 1RM ) . Outcome measures included 1RM strength and peak power ( PP ) . Total leg lean mass was determined using dual-energy X-ray absorptiometry to estimate specific strength and specific PP . Results : During training , power output was consistently higher in POW compared to STR for knee extension ( ∼2.3-fold ) and leg press ( ∼2.8-fold ) exercises ( p<0.01 ) . Despite this , PP and specific PP of the knee extensors increased similarly from baseline in POW and STR compared to CON ( p<0.01 ) , and no significant time-group interaction occurred for PP of the leg extensors . However , gains in leg press specific PP were significantly greater in POW compared to both STR and CON ( p<0.05 ) . Total leg lean mass did not change within any group . Conclusions : A short-term intervention of high-velocity power training and traditional slow-velocity progressive resistance training yielded similar increases of lower extremity power in the mobility-impaired elderly . Neuromuscular adaptations to power training , rather than skeletal muscle hypertrophy , may have facilitated the improvements in muscle quality . Additional studies are warranted to test the efficacy of power training in older individuals with compromised physical functioning STUDY DESIGN R and omized multicenter retrospective chart review of medical referral diagnoses and corresponding referral , patient , and physician demographic data . OBJECTIVE To examine the information content of medical referral diagnoses  provided to  outpatient physical therapists  with respect to physician and patient characteristics . BACKGROUND Previous studies indicate that physicians commonly provide nonspecific referral diagnoses to physical therapists . The effects of patient and physician characteristics on information contained in referral diagnoses are not well eluci date d. METHODS AND MEASURES A team of blinded raters categorized the information content of  referral diagnoses ( n = 2183 ) using a classification system adapted from a previous study . RESULTS One third ( 32 % ) of analyzed diagnoses were anatomically oriented and reported specific pathology . These specific diagnoses were provided significantly more commonly by specialist physicians ( odds ratio [ OR ] , 3.4 ; 95 % confidence interval [ CI ] , 2.7 - 4.2 ; P < .001 ) , male physicians ( OR , 2.2 ; 95 % CI , 1.6 - 3.1 ; P < .001 ) , both early- and late-career physicians ( P < .001 ) , and for male patients ( OR , 1.3 ; 95 % CI , 1.1 - 1.6 ; P < .05 ) . CONCLUSION Nonspecific referral diagnoses are frequently provided to physical therapists by physicians . The practice of evidence -based physical therapy seems challenged by the high rate of nonspecific referral diagnoses . Physical therapists may also have the responsibility to conduct differential diagnosis of pathology more commonly than formally recognized by many state practice acts and third-party payers BACKGROUND The Short Physical Performance Battery ( SPPB ) , which includes walking , balance , and chair st and s tests , independently predicts mobility disability and activities of daily living disability . To date , however , there is no definitive evidence from r and omized controlled trials that SPPB scores can be improved . Our objective was to assess the effect of a comprehensive physical activity ( PA ) intervention on the SPPB and other physical performance measures . METHODS A total of 424 sedentary persons at risk for disability ( ages 70 - 89 years ) were r and omized to a moderate-intensity PA intervention or a successful aging ( SA ) health education intervention and were followed for an average of 1.2 years . RESULTS The mean baseline SPPB score on a scale of 0 - 12 , with 12 corresponding to highest performance , was 7.5 . At 6 and 12 months , the PA versus SA group adjusted SPPB ( + /- st and ard error ) scores were 8.7 + /- 0.1 versus 8.0 + /- 0.1 , and 8.5 + /- 0.1 versus 7.9 + /- 0.2 , respectively ( p < .001 ) . The 400-meter walking speed was also significantly improved in the PA group . The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk ( hazard ratio = 0.71 , 95 % confidence interval = 0.44 - 1.20 ) . CONCLUSIONS A structured PA intervention improved the SPPB score and other measures of physical performance . An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes , such as mobility disability 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 BACKGROUND Decreased muscle strength impedes elders ' functional performance in daily activities such as gait . The mechanisms whereby increased strength improves gait are unknown . METHODS A prospect i ve , blinded , r and omized trial of moderate intensity strength exercise was conducted and its impact was measured on functional mobility during gait in 132 functionally limited elders . Lower extremity strength was measured , including hip abductor , hip extensor , and knee extensor strength . Of the 132 subjects , 120 subjects ( mean age , 75.1 yrs ) completed 6 months of elastic b and resistance training at least 3 times a week or served as no-exercise controls . RESULTS Subjects increased their lower extremity strength in the exercise and control groups , by 17.6 % and 7.3 % ( p < .01 ) , respectively . Gait stability improved significantly more in the exercise group than in the control group ( p < .05 ) . Increases in forward gait velocity were not significantly different between groups . Peak mediolateral velocity and base of support improved in the exercise group , but not in the control group . Change in lower extremity strength correlated significantly but weakly with many of the gait variables . CONCLUSIONS Gait stability , especially mediolateral steadiness , improved in the exercise group but not in the control group . These results show that even moderate strength gains benefit gait performance in elders and thus provide a sound basis for encouraging low-intensity strength training for elders with functional limitations OBJECTIVES To evaluate the validity and reliability of a st and ardized approach for assessing life-space mobility ( the University of Alabama at Birmingham Study of Aging Life-Space Assessment ( LSA ) ) and its ability to detect changes in life-space over time in community-dwelling older adults . DESIGN Prospect i ve , observational cohort study . SETTING Five counties ( three rural and two urban ) in central Alabama . PARTICIPANTS Community-dwelling Medicare beneficiaries ( N=306 ; 46 % male , 43 % African American ) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews . MEASUREMENTS The LSA assessed the range , independence , and frequency of movement over the 4 weeks preceding assessment s. Correlations between the baseline LSA and measures of physical and mental health ( physical performance , activities of daily living , instrumental activities of daily living , a global measure of health ( the short form-12 question survey ) , the Geriatric Depression Scale , and comorbidities ) established validity . Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change . RESULTS For all LSA scoring methods , baseline and 2-week follow-up LSA correlations were greater than 0.86 ( 95 % confidence interval=0.82 - 0.97 ) . Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility . The LSA showed both increases and decreases at 6 months . DISCUSSION Life-space correlated with observed physical performance and self-reported function . It was stable over a 2-week period yet showed changes at 6 months OBJECTIVES To evaluate weighted stair climbing exercise ( SCE ) as a means of increasing lower extremity muscle power in mobility-limited older people . DESIGN Single-blinded , r and omized controlled pilot study . SETTING Human physiology laboratory of a metropolitan university . PARTICIPANTS Forty-five community-dwelling people aged 65 and older who had baseline mobility limitations manifested by scores of 11 or lower on the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Subjects were r and omized into one of two 12-week exercise programs . The intervention group ( SCE ) ( n = 23 ) ascended and descended stairs , at a set pace , while wearing a weighted vest . The control group ( WALK ) ( n = 22 ) participated in a st and ardized walking program . MEASUREMENTS Primary and secondary outcomes included measures of muscle power and strength , submaximal aerobic capacity , and physical performance . RESULTS SCE produced 17 % improvement in double leg press peak power in comparison with WALK ( P = .013 ) and significant improvement in stair climbing power from baseline ( 12 % ) . Improvement in submaximal aerobic performance was equivalent for both groups . Although not statistically significant , effect size estimates suggest that SCE can potentially influence knee extension power and strength . Stair climb time was improved in both groups , whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants . CONCLUSIONS These findings suggest that SCE maybe a useful component of a home exercise program design ed to enhance lower extremity muscle power , aerobic capacity , and functional performance . Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training BACKGROUND AND PURPOSE The University of Alabama at Birmingham ( UAB ) Study of Aging Life-Space Assessment ( LSA ) is a relatively new instrument to measure mobility . The purpose of this report is to describe the relationships between LSA and traditional measures of physical function , sociodemographic characteristics , depression , and cognitive status . SUBJECTS Subjects were a stratified r and om sample of 998 Medicare beneficiaries aged > or = 65 years . The sample was 50 % African American , 50 % male , and 50 % from rural ( versus urban ) counties . METHODS In-home interviews were conducted . Mobility was measured using the LSA , which documents where and how often subjects  travel and any assistance needed during the 4 weeks prior to the assessment . Basic activities of daily living ( ADL ) and instrumental activities of daily living ( IADL ) , cognitive status , income level , presence of depressive symptoms , and transportation re sources were determined . The  Short Physical Performance Battery ( SPPB ) was used to assess physical performance . RESULTS Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence ( rural versus urban ) . In a regression model , physical function ( ADL , IADL ) and physical performance ( SPPB ) accounted for 45.5 % of the variance in LSA scores . An additional 12.7 % of the variance was explained by sociodemographic variables , and less than 1 % was explained by cognition and depressive symptoms . DISCUSSION AND CONCLUSION The LSA can be used to document patients ' mobility within their home and community . The LSA scores are associated with a person 's physical capacity and other factors that may limit mobility . These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits OBJECTIVES To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospect i ve association between inflammation and disability found in many studies . DESIGN Cohort study of older women with moderate to severe disability . PARTICIPANTS Six hundred twenty older women from the Women 's Health and Aging Study in whom information on baseline IL-6 serum level was available . MEASUREMENTS Self-report of functional status , objective measures of walking performance , and knee extensor strength were assessed at baseline and over six semiannual follow-up visits . Potential confounders were baseline age , race , body mass index , smoking , depression , and medical conditions . RESULTS At baseline , women with high IL-6 were more often disabled and had lower walking speed . After adjusting for confounders , women in the highest IL-6 tertile ( IL-6>3.10 pg/mL ) were at higher risk of developing incident mobility disability ( risk ratio ( RR ) = 1.50 , 95 % confidence interval ( CI ) = 1.01 - 2.27 ) , disability in activities of daily living ( RR = 1.41 , 95 % CI = 1.01 - 1.98 ) , and severe limitation in walking ( RR = 1.61 , 95 % CI = 1.09 - 2.38 ) and experienced steeper declines in walking speed ( P < .001 ) than women in the lowest IL-6 tertile ( IL-6 < or = 1.78 pg/mL ) . Decline in knee extensor strength was also steeper , but differences across IL-6 tertiles were not significant . After adjusting for change over time in knee extensor strength , the association between high IL-6 and accelerated decline of physical function was no longer statistically significant . CONCLUSIONS Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels , which are partially explained by a parallel decline in muscle strength Elderly participants experiencing difficulty in chair rising and with a maximum knee-extensor torque below 87.5 N . m were r and omized  to different versions of a strength-training program for the knee-extensors : to a high-guidance group ( HG ; two group sessions supervised by a physical therapist and one unsupervised home session per week , n = 17 ) , a medium-guidance group ( MG ; one supervised group session and two unsupervised home sessions per week , n = 16 ) , or a control group ( C ; no exercise , n = 16 ) . Maximal isometric knee strength increased more in HG than in C ( p = .03 ) and with increasing guidance ( p = .03 ) . The effect was mainly the result of participants with low initial strength . Walking speed increased more for HG than for C ( p = .02 ) and than for MG ( p = .06 ) . No statistically significant improvements were seen on other functional tests . In summary , the study shows a trend toward better results with more supervision , but more and larger studies are needed to confirm this OBJECTIVES To examine joint associations of physical activity and adiposity measures ( body mass index ( BMI ) , waist circumference , percentage body fat ) with incident mobility limitation . DESIGN Prospect i ve observational cohort study . SETTING Memphis , Tennessee and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and nine hundred and eighty-two black and white men and women aged 70 to 79 participating in the Health , Aging and Body Composition ( Health ABC ) study . MEASUREMENTS Mobility limitation was defined as reported difficulty walking one-quarter of a mile or climbing 10 steps during two consecutive semiannual assessment s over 6.5 years . Three measures of adiposity were included in this study : BMI , total percentage body fat , and waist circumference . Physical activity  was assessed using a modified leisure-time physical activity question naire . RESULTS Forty-six percent of the cohort developed mobility limitation .  White and black men with a high BMI ( > or = 30 kg/m(2 ) ) , high total percentage body fat ( > 31.3 % ) , or high waist circumference ( > or = 102 cm ) had an approximately 60 % , 40 % , and 40 % , respectively , higher risk of incident mobility limitation than those with low adiposity . In women , high adiposity was also associated with a significantly higher mobility limitation risk than in those with low adiposity . Low physical activity ( lowest quartile ) was associated with a 70 % higher risk of mobility limitation in all groups . Persons with high adiposity and low physical activity were at particularly high risk of mobility limitation .  People with high adiposity who were physically active had an equally high risk of mobility limitation as inactive people with low adiposity . CONCLUSION High adiposity and low self-reported physical activity predicted the onset of mobility limitation in well-functioning older persons . Preventing weight gain in old age and promoting physical activity in obese and non-obese older persons may therefore be effective strategies to prevent mobility loss and future disability Objective : To establish the effects of group exercise on mobility and strength . Design : R and omized controlled trial . Setting : Two public hospital outpatient rehabilitation services . Participants : One hundred and seventy-three people ( mean age 74.9 years , SD 10.8 ) with impaired mobility were r and omized and 159 people ( 92 % ) completed the trial . Interventions : Five-week , twice-weekly ` circuit-style ' group exercise programme run by a physiotherapist ( n = 85 ) and a no-intervention waiting list control group ( n = 88 ) . Main outcome measures : Three aspects of mobility : balance while st and ing and stepping ( Step Test , semi-t and em and t and em stance times ) ; sit-to-st and ability ( rate and minimum height ) and gait ( 6-metre and 6-minute walk tests ) . Lower limb muscle strength ( knee flexion and extension ) . Results : At retest , exercise participants had improved significantly more than their control counterparts on measures of balance while stepping , sit to st and and gait . Exercise participants averaged 1.6 more steps on the 15-second Step Test ( 95 % confidence interval ( CI ) 0.5 to 2.8 , P=0.005 ) , walked an average of 0.12 m/s faster ( 95 % CI 0.05 to 0.2 , P=0.002 ) and took 2.5 fewer steps in 6 metres ( 95 % CI —4.2 to —0.8 , P=0.004 ) . Exercise participants also averaged 0.04 more sit-to-st and s/second , ( 95 % CI 0.003 to 0.08 , P=0.037 ) and walked an average of 30.9 metres further in 6 minutes ( 95 % CI 9.4 to 52.4 , P=0.005 ) . There were no clinical ly important or statistically significant between-group differences at retest for the measures of strength ( knee extension and flexion ) , balance while st and ing or minimal sit-to-st and height . Conclusion : This short- duration circuit class programme improved mobility , but not strength PURPOSE To compare the effects of functional home exercise of repeated sit-to-st and s with low-intensity progressive resistance training , on performance measures in mobility-limited adults over 80 years of age . SETTING Participants ' homes . DESIGN Community-dwelling older adults > or = 80 years of age were invited to participate in a r and omised controlled clinical trial . Baseline and outcome measures were : comfortable gait velocity , 30-s chair-st and test , 15-s step test , Berg Balance Scale , Modified Falls Efficacy Scale and the Late-Life Function and Disability Instrument-function component . Participants r and omised to the intervention group performed repeated sit-to-st and s using a Gr and St and System ; a biofeedback device that recorded and displayed the number of repetitions performed . Participants r and omised to the control group performed knee extensions using ankle cuff weights . Both groups performed the exercises daily for 6 weeks . RESULTS Sixty-six older adults took part . The intervention group had a statistically significant improvement in Berg Balance Scale mean score , 1.67 + /- 2.64 points , P = 0.001 ( control group 0.73 + /- 3.63 points , P = 0.258 ) , indicating an improvement in balance over the 6-week exercise period . There was no statistically significant effect of either intervention on the other outcome measures . CONCLUSIONS In a highly variable population of older adults with mobility limitations , low-intensity functional home exercise of repeated sit-to-st and s using the Gr and St and System improved Berg Balance Scale score while low-intensity progressive resistance training did not . While statistically significant , the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinical ly significant in this population 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 Background Due to the many problems associated with reduced balance and mobility , providing an effective and engaging rehabilitation regimen is essential to progress recovery from impairments and to help prevent further degradation of motor skills . Objectives The purpose of this study was to examine the feasibility and benefits of physical therapy based on a task-oriented approach delivered via an engaging , interactive video game paradigm . The intervention focused on performing targeted dynamic tasks , which included reactive balance controls and environmental interaction . Design This study was a r and omized controlled trial . Setting The study was conducted in a geriatric day hospital . Participants Thirty community-dwelling and ambulatory older adults attending the day hospital for treatment of balance and mobility limitations participated in the study . Interventions Participants were r and omly assigned to either a control group or an experimental group . The control group received the typical rehabilitation program consisting of strengthening and balance exercises provided at the day hospital . The experimental group received a program of dynamic balance exercises coupled with video game play , using a center-of-pressure position signal as the computer mouse . The tasks were performed while st and ing on a fixed floor surface , with progression to a compliant sponge pad . Each group received 16 sessions , scheduled 2 per week , with each session lasting 45 minutes . Measurements Data for the following measures were obtained before and after treatment : Berg Balance Scale , Timed “ Up & Go ” Test , Activities-specific Balance Confidence Scale , modified Clinical Test of Sensory Interaction and Balance , and spatiotemporal gait variables assessed in an instrumented carpet system test . Results Findings demonstrated significant improvements in posttreatment balance performance scores for both groups , and change scores were significantly greater in the experimental group compared with the control group . No significant treatment effect was observed in either group for the Timed “ Up & Go ” Test or spatiotemporal gait variables . Limitations The sample size was small , and there were group differences at baseline in some performance measures . Conclusion Dynamic balance exercises on fixed and compliant sponge surfaces were feasibly coupled to interactive game-based exercise . This coupling , in turn , result ed in a greater improvement in dynamic st and ing balance control compared with the typical exercise program . However , there was no transfer of effect to gait function 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 BACKGROUND Relatively little is known about why older persons develop long-term disability in community mobility .  OBJECTIVE To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car . DESIGN Prospect i ve cohort study from March 1998 to December 2009 . SETTING Greater New Haven , Connecticut . PARTICIPANTS 641 persons , aged 70 years or older , who were active drivers or nondisabled in walking a quarter mile . Persons who were physically frail were over sample d. MEASUREMENTS C and i date risk factors were assessed every 18 months .  Disability in community mobility and exposure to potential precipitants , including illnesses or injuries leading to hospitalization or restricted activity  , were assessed every month . Disability that lasted 6 or more consecutive months was considered long-term . RESULTS 318 ( 56.0 % ) and 269 ( 53.1 % ) participants developed long-term disability in walking and driving , respectively . Seven risk factors were independently associated with walking disability and 8 were associated with driving disability ; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery . The precipitants had a large effect on long-term disability , with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity . The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized . LIMITATIONS The observed associations may not be causal . The severity of precipitants was not assessed . The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated . CONCLUSION Long-term disability in community mobility is common among older persons . Multiple risk factors , together with subsequent precipitants , greatly increase the likelihood of long-term mobility disability . PRIMARY FUNDING SOURCE National Institute on Aging , National Institutes of Health
target: 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
background: 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 .