Association Between a Hybrid Video-Guided Multicomponent Exercise Program With Staff Assistance and Free-Living Gait in Older Adults With Knee and Low Back Pain: Secondary Analysis of a Randomized Controlled Trial

Abstract Background Older adults with chronic joint pain often exhibit decreased mobility. Daily walking measures are being increasingly used in aging research as objective indicators of mobility. Objective In this study, we aimed to examine the effects of a 12-week hybrid exercise-based program on daily-life walking characteristics. Methods A total of 59 community-dwelling older adults (aged ≥65 years) with mild to moderate knee and/or low back pain were randomized to either a hybrid exercise group or an educational control group. Daily-life walking was monitored using an ankle sensor. Daily observation data were collected within 2 planned 7-day windows. Primary parameters included activity volume and gait characteristics. Statistical analyses were conducted based on a modified intention-to-treat principle using linear mixed-effects models, with a per-protocol set used for sensitivity analyses. Results The mixed-effects analysis based on the modified intention-to-treat principle (n=52 participants; 696 observations) suggested an effect of the intervention on improving walking quality, particularly step length (β=2.39 cm; P =.04; Hedges g =0.493), with a smaller effect with borderline statistical significance observed on improving walking speed (β=0.05 m/s; P =.06; Hedges g =0.496). Cadence, daily distance, daily steps, active energy expenditure, and accumulated 3 or more metabolic equivalent of task activities showed no clear difference between the groups. In the per-protocol sensitivity analysis (n=44), the same directional pattern of improvement was observed for step length (β=1.95 cm; P =.13; Hedges g =0.365) and walking speed (β=0.04 m/s; P =.14; Hedges g =0.368); however, the estimates were imprecise. Conclusions A 12-week hybrid exercise program may improve the quality of daily-life walking, with the clearest effect observed on step length. Given the attenuation after multiplicity-aware interpretation and in sensitivity analyses, these findings should be interpreted as suggestive rather than definitive.