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Effect of a six-week virtual reality treadmill training falls prevention intervention on macro gait outcomes of free-living walking activity

Del Din, S., Lord, S., Godfrey, A., Galna, B.ORCID: 0000-0002-5890-1894, Bekkers, E., Pelosin, E., Nieuwhof, F., Mirelman, A., Hausdorff, J. and Rochester, L. (2017) Effect of a six-week virtual reality treadmill training falls prevention intervention on macro gait outcomes of free-living walking activity. In: 2017 International Society of Posture and Gait Research (ISPGR) World Congress, 26-29 June 2017, Fort Lauderdale, FL, USA.



BACKGROUND AND AIM: Gait impairments are frequent among older adults and associated with fall risk. Intervention programmes aiming to reduce fall risk (e.g. balance exercise programs) usually focus on single risk factors (i.e. either motor or cognitive performance). The effects of interventions on free-living walking activity are still not clear and need to be explored. Recently, the V-TIME study showed that a six week multimodal intervention programme of treadmill training combined with a virtual reality component (TTVR) lowered the incidence of falls more than an intensity-matched intervention with treadmill training (TT) only [1]. The aim of this exploratory analysis was to examine the hypothesis that a lower fall risk due to the TTVR intervention would be mediated by change in volume, pattern and variability (macro gait outcomes) of free living walking activity.

METHODS: 165 older adults (age: 74±7 years) including: 72 elderly fallers (EF), 24 people with mild cognitive impairment (MCI) and 69 people with Parkinson's disease (PD), who had fallen twice or more in the previous 6 months were assessed. Participants were randomly assigned to TT or TTVR interventions and tested at baseline and after the intervention (1 week, 1 month and 6 months) [1]. For each assessment free-living data were recorded for 7 days with an accelerometer (Axivity AX3) placed on the lower back. Macro gait outcomes representing the volume (% walking time, number of bouts per day, number of steps, mean bout length), pattern (alpha), and variability of free-living walking activity were extracted in MATLAB® (R2012a) [2]. General linear models were used to examine the effect of Group (EF vs PD vs MCI), Time and Intervention on macro gait, controlling for age and sex.

RESULTS: Macro gait outcomes did not changed over time (main effect for Time p > 0.05). In addition, there were no significant Group x Time or Intervention x Time interactions. This suggests the lack of change was consistent between groups and intervention type. We repeated the analysis including different thresholds of bout length (bouts over 10 seconds and 60 seconds) with similar results. Significant group effects (EF vs PD vs MCI) showed that PD had more variable bout lengths compared to EF and MCI (p ≤ 0.016).

CONCLUSIONS: This exploratory work showed that despite reducing the incidence of falls, a 6 week treadmill training intervention (with or without VR augmentation) did not change macro gait outcomes (volume, pattern and variability) in older adult fallers who managed to sustain free-living walking activity while reducing fall risk. Reduction in falls rate due to treadmill training does not seem to be mediated by a change in macro gait outcomes of free-living walking activity.

REFERENCES: [1]Mirelman A et al, Lancet, 2016; 388(10050):1170-82 [2]Lord S et al, J Neurol., 2013; 260(12):2964-72

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