Adherence to and effects of multidirectional stepping exercise in the elderly: A long-term observational study following a randomized controlled trial

Abstract

Few exercises that encourage elderly persons to be physically active have been proved to exhibit both method-effectiveness (efficacy) and use-effectiveness (effectiveness) in a long-term setting. We recently developed a square-stepping exercise (SSE) for elderly persons and assessed its effects on adherence and functional fitness in a long-term, observational setting following a randomized controlled trial (RCT). Sixty-eight people (SSE group, n = 32; walking group, n = 36) participated in a 3-month RCT. At the end of the RCT period, they were encouraged to continue the assigned exercise autonomously. We measured adherence to the assigned exercise for a total of 4 years and their functional fitness after 1 and 4 years. Functional fitness measurements at each follow-up point and at the 3-month intervention entry were compared in terms of method-effectiveness (per-protocol based [PPB]) and use-effectiveness (intention-to-treat [ITT]). At the 1-year and 4-year follow-ups, 69% and 63%, respectively, of the SSE group had continued performing the assigned exercise. These values were comparable to those of the walking group (65% and 65%). From the PPB and ITT analyses, we found that SSE was as effective—or more effective—than walking with regard to functional fitness. In conclusion, SSE is a good exercise choice that is recommended for the elderly on a long-term basis.

Keywords

• follow-up studies
• exercise therapy
• intention to treat analysis