Mélanie Le Berre,1,2 LizFerland,3 Shawn Robbins,4,5 The effectiveness and feasibility of a Nordic walking pole program for institutionalized older adults Mélanie Le Berre,1,2 LizFerland,3 Shawn Robbins,4,5 1Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada 2School of Rehabilitation, Université de Montréal, Montreal, Canada 31Saint-Anne’s Veterans Hospital, Quebec, Canada 4School of Physical and Occupational Therapy, McGill University, Quebec, Canada 5Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, Quebec, Canada

Background Objective Physical activity helps maintain functional independence and decreases fall risk.1 Nordic pole walking (NW) programs were shown to be beneficial for improving mobility in community-dwelling adults.2,3 Similar programs have however not been tested in much older institutionalized adults. Determine the feasibility and effectiveness for improving walking and balance of a Nordic pole walking program in institutionalized older adults. 1. El-Khoury et al, 2013; 2. Figueiredo et al, 2013; 3. Virag et al, 2015

Methods Design Intervention: NW program Participants Pre-post pilot study. 12 weeks, 20 minutes sessions, 2 days/week Using NW “Activator” poles (Urban poling, Vancouver, BC) Number of pauses and walking distance were adapted to the needs and preferences of each participant Participants were accompanied by an experienced physical rehabilitation therapist and a physical rehabilitation therapist trainee for the walk Set inside due to weather (winter) Participants Eligibility criteria: Berg Balance Scale score over 30/56 Walking endurance of at least 30m with usual gait aid and supervision Exclusion criteria: Unable to learn NW technique and to cooperate well Any weight bearing precautions, fractures or surgeries in the past 12 months Any myocardial infarction in the past 12 months or any other health condition that would prevent participation in the program

Methods Results Outcome measures Satisfaction Sociodemographic data Mean (SD) Minimum, Maximum Age (y) 93 (3) 89, 96 Height (m) 1.60 (0.06) 1.52, 1.68 Mass (kg) 68 (16) 45, 89 Body mass index (kg/m2) 26.59 (5.75) 19.40, 36.10 Charlson Comorbidity Index 6 (1) 5, 8 POST Satisfaction questionnaire PRE, POST and 3 months follow-up: Stepscan Pedway gait and standing balance analysis 10-Meter Gait Speed test Berg Balance Scale Falls history Table 1. Demographics for the study participants (n=7, 6 men) Satisfaction Two participants rated their satisfaction as 10/10 and one as 8/10 respectively. Five participants had difficult using the numeric rating, but expressed enjoyment and a desire to continue the program.

Results Measure Type Variable PRE Program POST Program Follow-Up p value Gait - Stepscan Walking Speed (m/s) 0.45 (0.26, 0.63) 0.47 0.36 (0.11, 0.56) 0.16 Stride Length (cm) 66.80 (52.28 85.07) 67.94 (50.83, 83.03) 63.17 (47.47, 72.54) 0.57 Cadence (steps/min) 79.36 (59.10, 101.33) 82.74 (59.27, 113.23) 66.74 (29.21, 101.95) Gait - Clinical 10-Meter Gait Speed (m/s) 0.60 (0.40, 0.77) 0.66 (0.47, 0.91) 0.63 (0.45, 0.79) 0.20 Balance - Stepscan COP Speed (cm/s) 4.32 (3.12, 6.34) 3.35 (2.69, 4.53) 3.77 (2.75, 5.18) 0.11 COP Area (cm2) 2.51 (1.56, 4.56) 2.59 (1.38, 3.92) 3.25 (1.71, 4.66) 0.14 Balance - Clinical Berg Balance Scale (/56) 38 (30, 44) 43 (34, 48) 39 (28, 45) <0.01 Adverse Events Falls 0.9 (0, 2) 0.0 (0, 0) 0.4 (0, 1) 0.17 Conclusion NW program is feasible and safe in older institutionalized adults NW improved balance, although the changes were not maintained 3 months after the program cessation No improvements in gait metrics Future studies should examine NW impact on falls, general function and the cardiovascular system in larger samples Table 2. Means (minimum, maximum) for the study variables at each assessment COP, Center of pressure