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Gait speed modifies efficacy of home-based exercise for falls in older adults with a previous fall: secondary analysis of a randomized controlled trial [with consumer summary]
Rice J, Falck RS, Davis JC, Hsu CL, Dian L, Madden K, Parmar N, Cook WL, Khan KM, Liu-Ambrose T
PTJ: Physical Therapy & Rehabilitation Journal 2025 Mar;105(3):pzaf008
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. The study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults. METHODS: This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were >= 70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow (< 0.80 m/s) or normal (>= 0.80 m/s)) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling. RESULTS: At baseline, 134 participants had slow (exercise 70; standard of care 64) and 210 had normal (exercise 102; standard of care 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio 0.56; 95% CI 0.33 to 0.95) but not at 12 months (incidence rate ratio 0.63; 95% CI 0.38 to 1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed Up and Go Test at 6 months (estimated mean difference -4.05; 95% CI -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference 2.51; 95% CI 0.81 to 4.21). CONCLUSION: Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.

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