JMIR Publications

ABSTRACT

Background:

Older adults with chronic joint pain often exhibit decreased mobility. Daily walking measures are being increasingly used in aging research as objective indicators of mobility.

Objective:

In this study, we aimed to examine the effects of a 12-week hybrid exercise-based program on daily-life walking characteristics.

Methods:

A total of 59 community-dwelling older adults (aged ≥65 years) with mild-to-moderate knee and/or low back pain were randomized to either a hybrid exercise group or an educational control group. Daily-life walking was monitored using an ankle sensor. Daily observation data were collected within 2 planned 7-day windows. Primary parameters included activity volume and gait characteristics. Statistical analyses were conducted based on the intention-to-treat principle using linear mixed-effects models, with a per-protocol set used for sensitivity analyses.

Results:

The mixed-effects analysis based on the intention-to-treat principle (n=52 participants, 696 observations) suggested an effect of the intervention on improving walking quality, particularly step length (β=2.39 cm, P=.042, g=0.493), with a smaller effect with borderline statistical significance, was observed on improving walking speed (β=.05 m/s, P=.063, g=0.496). Cadence, daily distance, daily steps, active energy expenditure, and accumulated ≥3 metabolic equivalent of task activities showed no clear difference between the groups. In the per-protocol sensitivity analysis (n=44), the same directional pattern, of improvement, was observed for step length (β=1.95 cm, P=.132, g=0.365) and walking speed (β= .04 m/s, P=.140, g=0.368); however, the estimates were imprecise.

Conclusions:

A 12-week hybrid exercise program may improve the quality of daily-life walking, with the clearest effect observed on step length. Given the attenuation after multiplicity-aware interpretation and in sensitivity analyses, these findings should be interpreted as suggestive rather than definitive. Keywords: hybrid video-guided multicomponent exercise program; randomized controlled trial; gait; active energy expenditure Clinical Trial: The trial was registered at the University Hospital Medical Information Network Clinical Trials Registry under the registration number UMIN000057169.