Motor learning versus standard walking exercise in older adults with subclinical gait dysfunction: a randomized clinical trial.

OBJECTIVES To compare the effect of motor learning with that of standard exercise on measures of mobility and perceived function and disability. DESIGN Single-blind randomized trial. SETTING University research center. PARTICIPANTS Older adults (n = 40) with a mean age of 77.1 ± 6.0, normal walking speed (≥ 1.0 m/s), and impaired motor skills (Figure of 8 walk time >8 seconds). INTERVENTIONS The motor learning program incorporated goal-oriented stepping and walking to promote timing and coordination within the phases of the gait cycle. The standard program employed endurance training by treadmill walking. Both included strength training and were offered twice weekly for 1 hour for 12 weeks. MEASUREMENTS Primary outcomes were mobility performance (gait efficiency, motor skill in walking, gait speed, walking endurance); secondary outcomes were perceived function and disability (Late-Life Function and Disability Instrument). RESULTS Thirty-eight of 40 participants completed the trial (motor learning, n = 18; standard, n = 20). The motor learning group improved more than the standard group in gait speed (0.13 vs 0.05 m/s, P = .008) and motor skill (-2.2 vs -0.89 seconds, P < .001). Both groups improved in walking endurance (28.3 and 22.9 m, P = .14). Changes in gait efficiency and perceived function and disability were not different between the groups (P > .10). CONCLUSION In older adults with subclinical gait dysfunction, motor learning exercise improved some parameters of mobility performance more than standard exercise.