Influence of a multicomponent exercise intervention on fear of falling and gait parameters in community-dwelling older adults: a prospective study

The effects of exercise interventions on gait parameters and fear of falling (FOF) have been under-explored and the influence of FOF on exercise-induced adaptations of gait parameters is unclear. This interventional and comparative pilot study aimed to explore the influence of FOF status on gait parameters changes following a multicomponent exercise intervention in community-dwelling older adults at risk of mobility disability and implemented in routine care. One-hundred five older adults (80.63 ± 5.80 years) completed a supervised group-based exercise (6–8 participants) intervention (10 weeks, 2x/week, 1 h). Participants of this open cohort and prospective study were divided a-posteriori in 2 subgroups: with FOF subgroup (Falls Efficacy Scale-International (FES-I) > 23; n = 64) or without FOF subgroup (FES-I ≤ 23; n = 41). A two-way repeated measure ANOVA was performed to measure time, group and group*time interactions effects. Paired t-test were performed to measure changes within the subgroups. Correlations were performed between FOF delta’s changes and gait parameters changes. Spatiotemporal gait parameters (i.e. gait speed; stride variability, symmetry, length; swing, stance and double support phases; lift and strike angles; number of cycles at the turn; turning angle), perceived gait quality (i.e. the “Locomotion” domain of the “SarQoL®” questionnaire), functional parameters (i.e. Short Physical Performance Battery and its subtests; Timed Up and Go) and FOF were assessed. A time effect was observed for all spatial gait parameters (p < .05), all functional parameters (p < .001), perceived gait quality (p < .001) and FOF (p < .01) assessed after the intervention for the total cohort. A group effect was observed for FOF (p < .001), spatiotemporal gait parameters (p < .05) and perceived gait quality (p < .001). A group*time interaction was only observed for FOF (p < .001). Stride length, lift off angle, strike angle and turning angle (p < .05) improved in both subgroups. Stride variability (p < .05) and FOF (p < .001) improved only in the FOF subgroup. Correlations between gait parameters changes and FOF changes were only observed in FOF subgroup for double support phase (r =.25, p < .05), swing phase (r =-.25, p < .05) and stance phase (r =.25, p < .05). A moderate correlation was observed between FOF changes and perceived gait quality changes (r =-.49, p < .01) in no-FOF subgroup. This correlation became weak for the total cohort (r =-.25, p < .05). Our results demonstrate that a multicomponent exercise intervention lead to significant changes in FOF, spatial gait parameters and perceived gait quality in older adults and more in those with FOF. Thus, this routine care intervention could be widely proposed to older adults at risk of falls, and particularly to those with a FOF. Finally, although FOF and gait parameters are related, their changes over time do not seem to be as related. This study confirmed that managing the FOF is complex, multifactorial and might be orientated to a holistic approach. NCT03667664 (registration date: 12/09/2018) and NCT06659484 (registration date: 26/10/2024).