IMPORTANCE: Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults. OBJECTIVE: To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults. DESIGN, SETTING, AND PARTICIPANTS: Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable. INTERVENTIONS: Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises. MAIN OUTCOMES AND MEASURES: The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals. RESULTS: Participants (mean (SD) age, 80.0 (8.1) years) were mostly female (251 (84.2%)) and white (249 (83.6%)) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 (0.13) versus -0.01 (0.11) m/s; adjusted difference 0.05 (0.02) m/s; p = 0.002) and 6-minute walk distance (20.6 (57.1) versus 4.1 (55.6) m; adjusted difference 16.7 (7.4) m; p = 0.03). Attendance was greater in the usual-care program compared with On the Move (95 (65.1%) versus 76 (50.0%) attended >= 20 classes; p = 0.03). There were no significant differences in any of the other primary or secondary outcomes. CONCLUSIONS AND RELEVANCE: The On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01986647.

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