Assessing mobility in older adults: the UAB Study of Aging Life-Space Assessment. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Physical activity in prefrail older adults: confidence and satisfaction related to physical function. Physical activity as a determinant of change in mobility performance: the Longitudinal Aging Study Amsterdam. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility Evaluating the effects of increasing physical activity to optimize rehabilitation outcomes in hospitalized older adults (MOVE Trial): study protocol for a randomized controlled trial Enhancing physical activity in older adults receiving hospital based rehabilitation: a phase II feasibility study Performance-Based Versus Patient-Reported Physical Function: What Are the Underlying Predictors? Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study Positive Effects of Physical Training in Activity of Daily Living–Dependent Older Adults Enhancing physical function in HIV-infected older adults: A randomized controlled clinical trial. Physical activity and leg strength predict decline in mobility performance in older persons. Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls?
BACKGROUND AND PURPOSE The University of Alabama at Birmingham ( UAB ) Study of Aging Life-Space Assessment ( LSA ) is a relatively new instrument to measure mobility . The purpose of this report is to describe the relationships between LSA and traditional measures of physical function , sociodemographic characteristics , depression , and cognitive status . SUBJECTS Subjects were a stratified r and om sample of 998 Medicare beneficiaries aged > or = 65 years . The sample was 50 % African American , 50 % male , and 50 % from rural ( versus urban ) counties . METHODS In-home interviews were conducted . Mobility was measured using the LSA , which documents where and how often subjects  travel and any assistance needed during the 4 weeks prior to the assessment . Basic activities of daily living ( ADL ) and instrumental activities of daily living ( IADL ) , cognitive status , income level , presence of depressive symptoms , and transportation re sources were determined . The  Short Physical Performance Battery ( SPPB ) was used to assess physical performance . RESULTS Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence ( rural versus urban ) . In a regression model , physical function ( ADL , IADL ) and physical performance ( SPPB ) accounted for 45.5 % of the variance in LSA scores . An additional 12.7 % of the variance was explained by sociodemographic variables , and less than 1 % was explained by cognition and depressive symptoms . DISCUSSION AND CONCLUSION The LSA can be used to document patients ' mobility within their home and community . The LSA scores are associated with a person 's physical capacity and other factors that may limit mobility . These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70 + years of age who have deficits in mobility . We r and omized a total of 412 adults aged 70 - 89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months . Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention . Gender , age , and scores on a short physical performance battery did not moderate these effects . Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning . This is an important finding in light of the importance of these process variables in behavior change and quality of life OBJECTIVES This study examined the association of ( change in ) physical activity and decline in mobility performance in older men and women . DESIGN A 3-year prospect i ve study using data of the Longitudinal Aging Study . SETTING Netherl and s. PARTICIPANTS Two thous and one hundred nine men and women aged 55 to 85 . MEASUREMENTS  Total physical activity  ( expressed as hours per day and kilocalories per day ) and sports participation  were measured using a vali date d , interviewer-administered question naire .  Mobility performance was assessed using two timed tests : 6-meter walk and repeated chair st and s. RESULTS Mobility performance declined for 45.6 % of the sample . At baseline , the mean time + /- st and ard deviation spent on total physical activity was 3.0 + /- 2.1 h/d or 719 + /- 543 kcal/d , and 56.6 % of the sample participated in sports . Sports participation and a higher level of total physical activity , walking , or household activity were associated with a smaller mobility decline . After 3 years , total physical activity declined , and only 53.4 % of those reporting sports at baseline continued doing so . Continuation of physical activity over time was associated with the smallest decline in mobility . The observed associations were similar for those with and without chronic disease ( P > 0.3 ) . The conclusions did not change after adjustment for potential confounders , including demographic and lifestyle variables , depression , and cognitive status . CONCLUSIONS Physical activity , and especially a regularly active lifestyle , may slow the decline in mobility performance . A beneficial effect was observed for sports and nonsports activities , independent of the presence of chronic disease IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 BACKGROUND : Physical activity ( PA ) reduces the rate of mobility disability , compared with health education ( HE ) , in at risk older adults . It is important to underst and aspects of performance contributing to this benefit . OBJECTIVE : To evaluate intervention effects on tertiary physical performance outcomes . DESIGN : The Lifestyle Interventions and Independence for Elders ( LIFE ) was a multi‐centered , single‐blind r and omized trial of older adults . SETTING : Eight field centers throughout the United States . PARTICIPANTS : 1635 adults aged 78.9 ± 5.2 years , 67.2 % women at risk for mobility disability ( Short Physical Performance Battery [ SPPB ] < 10 ) . INTERVENTIONS : Moderate PA including walking , resistance and balance training compared with HE consisting of topics relevant to older adults . OUTCOMES : Grip strength , SPPB score and its components ( balance , 4 m gait speed , and chair‐st and s ) , as well as 400 m walking speed . RESULTS : Total SPPB score was higher in PA versus HE across all follow‐up times ( overall P = .04 ) as was the chair‐st and component ( overall P < .001 ) . No intervention effects were observed for balance ( overall P = .12 ) , 4 m gait speed ( overall P = .78 ) , or grip strength ( overall P = .62 ) . However , 400 m walking speed was faster in PA versus HE group ( overall P = < .001 ) . In separate models , 29 % of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score , while 39 % was explained by change in the chair st and component . CONCLUSION : Lower extremity performance ( SPPB ) was significantly higher in the PA compared with HE group . Changes in chair‐st and score explained a considerable portion of the effect of PA on the reduction of major mobility disability‐consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability Background Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge . Physical activity levels in rehabilitation are also low . It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation  will lead to better mobility outcomes at discharge . Methods / Design A single blind , parallel-group , multisite r and omized controlled trial with blinded assessment of outcome and intention-to-treat analysis . The cost effectiveness of the intervention will also be examined . Older people ( age > 60 years ) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals . A computer-generated blocked stratified r and omization sequence will be used to assign 198 participants in a 1:1 ratio to either an ‘ enhanced physical activity ’ ( intervention ) group or a ‘ usual care plus ’ ( control ) group for the duration of their inpatient stay . Participants will receive usual care and either spend time each week performing additional physical activities such as st and ing or walking ( intervention group ) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games ( control group ) . Self-selected gait speed will be measured using a 6-meter walk test at discharge ( primary outcome ) and 6 months follow-up ( secondary outcome ) . The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge . Additional measures of mobility ( Timed Up and Go , De Morton Mobility Index ) , function ( Functional Independence Measure ) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up . The trial commenced recruitment on 28 January 2014 . Discussion This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation . These results will assist in the development of evidence d-based rehabilitation programs for this population .Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12613000884707 ( Date of registration 08 August 2013 ) ; Clinical Trials.gov Identifier NCT01910740 ( Date of registration 22 July 2013 ) Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes . Increased physical activity may improve mobility . The objective of this Phase II study was to evaluate the feasibility of a r and omized controlled trial ( RCT ) of enhanced physical activity in older adults receiving rehabilitation . Methods Patients admitted to aged care rehabilitation with reduced mobility were r and omized to receive usual care or usual care plus additional physical activity  , which was delivered by a physiotherapist or physiotherapy assistant . The feasibility and safety of the proposed RCT protocol was evaluated . The primary clinical outcome was mobility , which was assessed on hospital admission and discharge by an assessor blinded to group assignment . To determine the most appropriate measure of mobility , three measures were trialled ; the Timed Up and Go , the Elderly Mobility Scale and the de Morton Mobility Index . Results The protocol was feasible . Thirty-four percent of people admitted to the ward were recruited , with 47 participants r and omised to a control ( n = 25 ) or intervention group ( n = 22 ) . The rates of adverse events ( death , falls and readmission to an acute service ) did not differ between the groups . Usual care therapists remained blind to group allocation , with no change in usual practice . Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants . The de Morton Mobility Index was the most appropriate measure of mobility . Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible . A larger multi-centre RCT to establish whether this intervention is cost effective and improves mobility is warranted . Trial registration The trial was registered with the ANZTCR ( ACTRN12608000427370 ) Background Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function . Although conceived as representing similar concepts , differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically . Objective The purpose of this study was to compare the Short Physical Performance Battery ( SPPB ) with the function component of the Late-Life Function and Disability Instrument ( LLFDI ) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care . Design This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults ( N=137 ) with mobility limitations enrolled in a r and omized controlled trial of exercise . Methods A performance-based measure of function ( the SPPB ) and a self-report measure of function ( the LLFDI ) served as functional outcomes . Physiologic factors included measures of leg strength , leg velocity , and exercise tolerance test ( ETT ) duration , which served as a surrogate measure of aerobic capacity . Psychosocial and health factors included age , sex , height , body mass index , number of chronic conditions , depression , and falls efficacy . Results Separate multivariable regression models predicting SPPB and LLFDI scores described 33 % and 42 % of the variance in each outcome ( R2 ) , respectively . Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures . Leg strength and age were positively associated with SPPB scores , whereas number of chronic conditions , sex , and falls efficacy were associated with the LLFDI scores . Limitations This study included older adults with mobility limitations and may not generalize to other population s. Conclusions Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person 's functioning . The SPPB was associated with age and physiologic factors , whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors OBJECTIVE In older people , mobility impairments and physical inactivity are risk factors for further disability and death . We studied the interaction of physical activity and mobility impairment as a predictor of dependence and mortality . DESIGN A population -based , prospect i ve study . The data were collected in structured interviews in the year 1988 and 8 years later in the year 1996 as part of the Evergreen Project . PARTICIPANTS Subjects were 1109 independently living , at baseline 65- to 84-year-old people in the city of Jyvaskyla , in central Finl and . METHODS Participants were ranked into four groups : ( 1 ) Intact mobility and physically active ( Mobile-Active ) , ( 2 ) Intact mobility and sedentary ( Mobile-Sedentary ) , ( 3 ) Impaired mobility and physically active ( Impaired-Active ) , and ( 4 ) Impaired mobility and sedentary ( Impaired-Sedentary ) . The confounders adjusted for in the models included age , marital status , education , chronic conditions , smoking , and physical exercise earlier in life . RESULTS In men and women , the relative risk of death was two times greater in Impaired-Active and three times greater in Impaired-Sedentary groups than the risk of death in Mobile-Active groups . However , the risk of death did not differ between Mobile-Active and Mobile-Sedentary groups . The odds ratio for dependency ( 95 % confidence interval ) in Impaired-Sedentary men was 5.21 ( 1.44 - 18.70 ) and in Impaired-Sedentary women was 2.92 ( 1.52 - 5.60 ) compared to Mobile-Active groups . The risk of dependence did not differ significantly between Mobile-Active , Mobile-Sedentary , and Impaired-Active groups . CONCLUSIONS Mobility impairments predicted mortality and dependence . However , among people with impaired mobility , physical activity was associated with lower risks , whereas the risk did not differ according to activity level among those with intact mobility . Despite of their overall greater risk , mobility-impaired people may be able to prevent further disability and mortality by physical exercise Background We investigated if personal socioeconomic position ( SEP ) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly . Methods We used data from the Cardiovascular Health Study , a longitudinal , population -based examination of coronary heart disease and stroke among persons aged 65 and older in the United States . Results Among 3,684 persons without baseline mobility impairment , lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period , although the strengths of these associations varied by socioeconomic indicator and race/sex group . Conclusion Among independent-living elderly , SEP affected development of mobility impairment into later life . Particular effort should be made to prevent or delay its onset among the elderly with low income , education , and /or who live in economically disadvantaged neighborhoods The goal of this study was to determinate the effects of physical training in older adults with mobility limitations . Thirty frail women ( 84 ± 6 years ) were r and omly assigned to a training or control group for 12 weeks of upper body physical training ( UBT ) performed sitting on wheelchairs . Trained subjects showed a significant improvement in arms strength ( + 29 % ) , and shoulder flexibility ( + 10 cm ) but did not improve in arms circumference . The activities of daily living ( ADLs ) were improved ( + 77 % ) , cognitive function as defined by the Mini-Mental State Examination ( MMSE ) was maintained in the trained group ( + 3 % ) and declined in the control group ( −21 % ) . These results demonstrate that UBT in dependent older women with mobility limitations can increase strength and improve ADLs OBJECTIVE HIV-infected older adults ( HOA ) are at risk of functional decline . Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority . We conducted a r and omized , controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory ( SDT ) improves physical function , autonomous motivation , depression and the quality of life ( QOL ) in HOA . METHOD In total , 67 community-dwelling HOA with mild-to-moderate functional limitations were r and omized to 1 of 2 groups : a physical activity counseling group or the usual care control group . We used SDT to guide the development of the experimental intervention . Outcome measures that were collected at baseline and final study visits included a battery of physical function tests , levels of physical activity , autonomous motivation , depression , and QOL . RESULTS The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups . Overall physical performance , gait speed , measures of endurance and strength , and levels of physical activity improved in the treatment group compared to the control group ( p < .05 ) . Measures of autonomous regulation such as identified regulation , and measures of depression and QOL improved significantly in the treatment group compared with the control group ( p < .05 ) . Across the groups , improvement in intrinsic regulation and QOL correlated with an improvement in physical function ( p < .05 ) . CONCLUSION Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function , autonomous motivation , depression , and QOL in HOA with functional limitations . ( PsycINFO Data base OBJECTIVES To assess the extent to which physical activity and leg strength are associated with change in mobility  in older persons . DESIGN Prospect i ve , observational cohort study . SETTING Retirement communities across the Chicago metropolitan area participating in the Rush Memory and Aging Project . PARTICIPANTS Eight hundred eighty-six ambulatory older persons without dementia . MEASUREMENT Rate of change in mobility . RESULTS In a linear mixed-effects model that controlled for age , sex , education , and a term for baseline physical activity , a higher level of physical activity was associated with a slower rate of mobility decline ( estimate=0.006 , st and ard error (SE)=0.003 , P=.03 ) ; each additional hour of physical activity at baseline was associated with an approximately 3 % decrease in the rate of mobility decline . In a similar model , a higher level of baseline leg strength was associated with a slower rate of mobility decline ( estimate=0.031 , SE=0.132 , P=.02 ) ; each additional unit of leg strength at baseline was associated with an approximately 20 % decrease in the rate of mobility decline . In a final model , which included terms for physical activity and leg strength together , both were associated with decline in mobility . Furthermore , both remained associated with mobility even after controlling for body composition , balance , pulmonary function , cognition , history of joint pain , cardiovascular diseases and risk factors , and medications . CONCLUSION Physical activity and leg strength are relatively independent predictors of mobility decline  in older persons . Although physical activity may improve strength , the beneficial effect of physical activity on mobility is likely to involve other pathways Background Interventions that enhance mobility in frail older people are needed to maintain health and independence , yet definitive evidence of effective interventions is lacking . Our objective was to assess the impact of a multifactorial intervention on mobility-related disability in frail older people . Methods We conducted a r and omised , controlled trial with 241 frail community-dwelling older people in Sydney , Australia . Participants were classified as frail using the Cardiovascular Health Study definition , did not have severe cognitive impairment and were recently discharged from an aged care and rehabilitation service . The experimental group received a 12 month multifactorial , interdisciplinary intervention targeting identified frailty components . Two physiotherapists delivered a home exercise program targeting mobility , and coordinated management of psychological and medical conditions with other health professionals . The control group received usual care .  Disability in the mobility domain was measured at baseline and at 3 and 12 months using the International Classification of Functioning , Disability and Health framework . Participation ( involvement in life situations ) was assessed using the Life Space Assessment and the Goal Attainment Scale . Activity ( execution of mobility tasks ) was measured using the 4-metre walk and self-report measures . Results The mean age of participants was 83.3 years ( SD : 5.9 years ) . Of the participants recruited , 216 ( 90 % ) were followed-up at 12 months . At this time point , the intervention group had significantly better scores than the control group on the Goal Attainment Scale ( odds ratio 2.1 ; 95 % confidence interval ( CI ) 1.3 to 3.3 , P = 0.004 ) and Life Space Assessment ( 4.68 points , 95 % CI 1.4 to 9.9 , P = 0.005 ) . There was no difference between groups on the global measure of participation or satisfaction with ability to get out of the house . At the activity level , the intervention group walked 0.05 m/s faster over 4 m ( 95 % CI 0.0004 to 0.1 , P = 0.048 ) than the control group , and scored higher on the Activity Measure for Post Acute Care ( P < 0.001 ) . Conclusions The intervention reduced mobility-related disability in frail older people . The benefit was evident at both the participation and activity levels of mobility-related disability . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : ANZCTRN12608000507381 OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved
Several tools are available to assess mobility in the ambulatory setting .
Relatively few studies support therapeutic exercise to improve mobility limitation .
Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders .
Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function , safety , and quality of life for patients with mobility limitations
IMPORTANCE Mobility limitations are common in older adults , affecting the physical , psychological , and social aspects of an older adult 's life .
OBJECTIVE To identify mobility risk factors , screening tools , medical management , need for physical therapy  , and efficacy of exercise interventions for older primary care patients with limited mobility .