title: What type, or combination of exercise can improve preferred gait speed in older adults? A meta-analysis.
abstract: BACKGROUND
  Improved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses.
  
  
  OBJECTIVE
  to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed.
  
  
  METHODS
  
  
  
  METHODS
  A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library.
  
  
  METHODS
  Randomized controlled trials of exercise interventions for older adults ≥ 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was ≤4, or if participants were selected for a specific neurological or neurodegenerative disease, Chronic Obstructive Pulmonary Disease, cardiovascular disease, recent lower limb fractures, lower limb joint replacements, or severe cognitive impairments. The meta-effect is presented in Forest plots with 95 % confidence
  
  
  METHODS
  intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed.
  
  
  RESULTS
  Twenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention- and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects.
  
  
  CONCLUSIONS
  Progressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait.
  
  
  CONCLUSIONS
  The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoided, there are probably differences in health status within different studies.
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. r.van.abbema@pl.hanze.nl.
authors.forename: Renske
authors.initials: R
authors.lastname: Van Abbema
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. m.h.g.de.greef@pl.hanze.nl.|Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands. m.h.g.de.greef@pl.hanze.nl.
authors.forename: Mathieu
authors.initials: M
authors.lastname: De Greef
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. c.craje@pl.hanze.nl.
authors.forename: Celine
authors.initials: C
authors.lastname: Crajé
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. w.p.krijnen@pl.hanze.nl.
authors.forename: Wim
authors.initials: W
authors.lastname: Krijnen
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. j.s.m.hobbelen@pl.hanze.nl.
authors.forename: Hans
authors.initials: H
authors.lastname: Hobbelen
authors.affiliation: Research group Healthy Ageing, Allied Health Care and Nursing - Hanze University Groningen, University of Applied Sciences, PO Box 3109, 9701, DC, Groningen, The Netherlands. c.p.van.der.schans@pl.hanze.nl.|Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands. c.p.van.der.schans@pl.hanze.nl.
authors.forename: Cees
authors.initials: C
authors.lastname: Van Der Schans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D055070:Resistance Training / Q000379:methods*