OBJECTIVE: To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait. DESIGN: Single-blinded randomized clinical trial. SETTING: University research laboratory. PARTICIPANTS: Adults (n = 40) aged > 65 years with gait speed > 1.0m/s and impaired motor skill (figure-of-8 walk time > 8s). INTERVENTIONS: The 2 interventions included a task-oriented motor learning and a standard exercise program; both interventions included strength training. Both lasted 12 weeks, with twice-weekly, 1-hour, physical therapist-supervised sessions. MAIN OUTCOME MEASURES: Two measures of the motor control of gait, gait variability and smoothness of walking, were assessed pre- and postintervention by assessors masked to the treatment arm. RESULTS: Of 40 randomized subjects, 38 completed the trial (mean age +/- SD 77.1 +/- 6.0y). The motor learning group improved more than the standard group in double-support time variability (0.13m/s versus 0.05m/s; adjusted difference (AD) 0.006, p = 0.03). Smoothness of walking in the anteroposterior direction improved more in the motor learning than standard group for all conditions (usual AD = 0.53, p = 0.05; narrow AD = 0.56, p = 0.01; dual task AD = 0.57, p = 0.04). Smoothness of walking in the vertical direction also improved more in the motor learning than standard group for the narrow-path (AD = 0.71, p = 0.01) and dual-task (AD = 0.89, p = 0.01) conditions. CONCLUSIONS: Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.

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