Lifestyle-integrated functional exercise for fall prevention. How and why do walking characteristics change?

Background: The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. Objective: The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6-month follow-up and to determine which factors are associated with these changes. Material and methods: This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 +/- 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n= 153) or individually (LiFE; n= 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6-month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression. Results: The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance. Conclusion: The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).