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Randomized Controlled Trial
. 2025 Mar 3;105(3):pzaf008.
doi: 10.1093/ptj/pzaf008.

Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial

Jordyn Rice  1   2   3 , Ryan S Falck  1   2   3   4 , Jennifer C Davis  3   5 , Chun L Hsu  6 , Larry Dian  7 , Kenneth Madden  3   7   8 , Naaz Parmar  7 , Wendy L Cook  7 , Karim M Khan  3   9   10 , Teresa Liu-Ambrose  1   2   3
Affiliations
Randomized Controlled Trial

Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial

Jordyn Rice et al. Phys Ther. .

Erratum in

Abstract

Objective: Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults.

Methods: This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling.

Results: At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI [confidence interval] = 0.33-0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38-1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed "Up & Go" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81-4.21).

Conclusion: Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.

Impact: Older adults with slow gait speed may be a target population for exercise-based fall prevention.

Keywords: Cognitive Function; Exercise; Falls; Older Adults; Physical Function.

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Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) Study Flow Diagram of Participants in Exercise and Standard of Care Groups Stratified by Baseline Gait Speed.
Figure 2
Figure 2
Intervention Adherence for Participants in the Exercise Intervention Group Stratified by Baseline Gait Speed.
Figure 3
Figure 3
Cumulative Number of Falls Throughout Study Intervention Stratified by Baseline Gait Speed and Group Allocation.
See this image and copyright information in PMC

References

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