Characteristics associated with gait speed improvements from walking interventions for older adults: A responder analysis

Background

Some older adults benefit to a great degree from walking interventions and others experience little improvement. Understanding the personal characteristics associated with greater treatment response to different interventions could assist clinicians in providing patients with matched interventions to optimize both outcomes and resource use.

Research question

What personal characteristics are associated with improved gait speed for older adults participating in walking interventions?

Methods

This was a secondary analysis of 236 older adults from a trial comparing “Standard” (lower-extremity strength and walking endurance) to “Plus” (additional task-specific training for walking) interventions on gait speed in older adults (≥65 years). Predictors included sociodemographic characteristics, health status, physical performance, and self-reported function. We fitted linear regression models to 12-week change in gait speed.

Results

Predictors of improved gait speed in Standard group included: younger age (β=-0.015), lower BMI (β=-0.005), slower gait speed (β=-0.015), longer Figure 8 Walk time (β=0.010), and higher Late Life Function and Disability Instrument scores (β=0.003). The parsimonious set of multivariable predictors were never married (β=0.081), not a caregiver (β=0.208), no cancer history (β=-0.052), slower chair rise times (β=0.010), slower gait speed (β=-0.021), and better overall function and disability (β=0.006).

Predictors of improved gait speed in Plus group included: lower BMI (β=-0.004), farther Six-Minute Walk distance (β=0.014), and greater modified Gait Efficacy Scale (β=0.002). The parsimonious set of multivariable predictors were increased age (β=0.026), no cardiovascular disease (β=0.137), greater total physical activity counts per day (β=0.003), slower baseline gait speed (β=-0.072), and longer Six-Minute Walk distance (β=0.054).

Significance

Those with the combination of suboptimal physical performance and strong self-report of function may benefit from standard strength and conditioning. Individuals may best respond to task-specific training when health status and physical performance are suboptimal and not overtly compromised. Matching interventions with personal characteristics may enhance efficacy of treatments to improve walking in older adults.