Frail and prefrail adults who walked fast enough to reach a higher heart rate improved more than those who walked at a comfortable pace, in a cluster-randomised trial published in PLOS One on 30 September. The trial, run in the Chicago area and funded by the US National Institutes of Health, analysed 105 adults aged 60 and over with a mean age of 79. Both groups walked for 45 minutes three times a week for 16 weeks under supervision; one group aimed above 70% of maximum heart rate, the other stayed below 60%. Of the faster group, 69.6% improved by at least one frailty category against 46.4% of the comfortable-pace group, an odds ratio of 2.91 (95% confidence interval 1.19 to 7.13, p=0.02). The authors report that this primary result did not stay statistically significant once missing data were imputed, and that 36% of those enrolled dropped out before analysis.
What the secondary measures showed
The faster group also gained more walking speed, a mean difference of 0.08 metres per second (95% CI 0.03 to 0.13, p=0.036), and covered a further 48.99 metres in a six-minute walk test (95% CI 21.1 to 76.9, p=0.0088). The two groups attended a similar number of sessions, so intensity was what differed between them. The authors list the small size, the absence of longer-term follow-up and limited diversity in the group, about three quarters of whom were white and the large majority women, among the trial's limitations.
What this means in practice
The trial recruited in the United States, not the UK, and tested supervised sessions rather than walking on your own. NHS guidance already draws the same distinction between moderate and vigorous activity. The NHS advises adults aged 65 and over to do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity, plus activities that improve strength, balance and flexibility on at least 2 days a week. This trial adds evidence on the intensity side of that guidance, in a group already living with frailty.
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