This randomized controlled trial compared two types of group exercise classes for older adults: a program to improve walking ability called On the Move and a standard group exercise program. The research team wanted to find out whether the On the Move program was better than the standard exercise program at improving walking ability and function and reducing disability in older adults.

The research team also wanted to know whether the On the Move program would be more sustainable if staff at senior living facilities and community centers, rather than exercise professionals, taught the classes. To that end, the study included a quasi-experimental component that compared program effectiveness by instructor type: exercise professionals versus facility staff. The exercise professionals included physical therapists and exercise physiologists. The facility staff who taught classes had varied backgrounds in teaching exercise.

Researchers randomized facilities based on the type of exercise program. If the researchers identified staff at a facility to teach the exercise program, the researchers then randomized participants at that facility by instructor type. Of the 32 facilities in the study, 16 used the On the Move program (201 participants: 152 taught by exercise professionals, 49 taught by facility staff), and 16 used the standard group exercise program (223 participants: 146 taught by exercise professionals, 77 taught by facility staff).

Participants in both types of exercise class met twice a week for 12 weeks. Each class had 10 or fewer participants. The exercises in the On the Move class took place in a standing position and focused on timing and coordination, which are important for walking. The standard group exercise program focused on strength, endurance, and flexibility; this class took place in a seated position for the entire class.

The study included 424 adults ages 65 and older who were able to walk independently. The mean patient age was 81 years. Some participants lived in independent-living facilities or senior apartment buildings; others lived in their own homes and attended senior community centers.

Primary outcomes were self-reported physical function and disability, measured by the Late-Life Function and Disability Instrument (LLFDI) function and disability frequency domains, and walking ability, measured by the six-minute walk test and gait speed. The research team collected data at baseline and immediately after participants completed their assigned 12-week intervention.

Results

Effectiveness: Participants in the On the Move program had greater improvement in the six-minute walk test than participants in the standard group exercise program did (p = 0.023). There were no significant differences between groups in gait speed or self-reported function and disability.

When exercise professionals taught both exercise programs, the On the Move participants had greater improvements in both measures of walking ability than participants in the standard group exercise program did (six-minute walk test, p = 0.026; gait speed, p = 0.0008).

Sustainability: Compared with participants in the On the Move classes taught by facility staff, participants in the On the Move classes taught by exercise professionals tended to have greater improvements in LLFDI overall function (p = 0.06) and gait speed (p = 0.06). The On the Move classes taught by facility staff did not elicit greater gains in study outcomes than standard group exercise classes taught by facility staff.

Limitations

This study took place in Pittsburgh, Pennsylvania; results may be different in other locations. The research team had difficulty identifying staff at senior living facilities to lead either group exercise class. The team was therefore unable to randomize participants by instructor type at all facilities and could not conduct adequately powered analyses as originally planned. A study with greater power might have been able to detect meaningful differences between the programs that this study could not. Attrition was greater in classes taught by facility staff; it is not clear whether this attrition was related to the instructors or to other factors. Facility staff trained to teach the On the Move class had varied training and exercise experience; however, researchers did not attempt to measure or quantify these differences.

Conclusions and Relevance

Compared with the standard group exercise program, the On the Move group exercise program elicited greater improvements in walking ability as measured by the six-minute walk test, when taught by exercise professionals. These findings suggest that the exercises included in the On the Move program may be beneficial for older adults. However, the findings also suggest that the program is more advantageous when taught by exercise professionals.

Future Research Needs

Future research could focus on finding ways to improve the effectiveness of classes taught by senior-center and assisted-living staff so that the classes they teach are as effective as those taught by exercise professionals.