Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise

Increased gait instability is common in older adults, even in the absence o f overt disease. The goal of the present study was to quantitatively invest igate the factors that contribute to gait instability and its potential rev ersibility in functionally impaired older adults. We studied 67 older men a nd women with functional impairment before and after they participated in a randomized placebo-controlled, 6-mo multimodal exercise trial. We found th at 1) gait instability is multifactorial; 2) stride time variability is str ongly associated with functional status and performance-based measures of f unction that have previously been shown to predict significant clinical out comes such as morbidity and nursing home admission; 3) neuropsychological s tatus and health-related quality of life play important, independent roles in gait instability; and 4) improvement in physiological capacity is associ ated with reduced gait instability. Although the etiology of gait instabili ty in older persons with mild-moderate functional impairment is multifactor ial, interventions designed to reduce gait instability may be effective in bringing about a more consistent and more stable walking pattern.