Fit and Strong! Plus: Twelve and eighteen month follow-up results for a comparative effectiveness trial among overweight/obese older adults with osteoarthritis.

This comparative effectiveness trial compared the longer-term effectiveness (12 and 18 months) of the standard Fit & Strong! physical activity program to Fit & Strong! Plus, which combined physical activity and dietary weight loss. Outcomes were weight, diet quality, physical activity, osteoarthritis symptoms, performance measures, and anxiety/depression. In this study, 413 overweight/obese participants with OA, ≥60 years old and primarily African American, were randomly assigned to Fit & Strong! (F&S!) or Fit & Strong! Plus (F&S! Plus), with outcomes assessed at 2, 6, 12, and 18 months. 356 (86%) participants completed the 18-month visit. Compared with participants randomized to standard F&S!, F&S! Plus participants maintained longer-term benefits at 12 months in weight (mean change ± SE: -1.7 ± 0.3 kg for F&S! Plus vs -0.9 ± 0.3 kg for F&S!, p = 0.049), BMI (-0.6 ± 0.1 vs -0.3 ± 0.1 kg/m2, p = 0.04), waist circumference (-2.7 ± 0.6 vs -0.4 ± 0.6 cm, p = 0.004), and lower extremity strength (1.6 ± 0.2 vs 1.0 ± 0.2 chair stands, p = 0.046). At 18 months, F&S! Plus participants showed improved lower extremity strength (1.4 ± 0.2 vs. 0.7 ± 0.2 chair stands, p = 0.045. African American older adults in the F&S! Plus arm showed sustained modest improvements in weight, waist circumference, and lower extremity strength at 12 months and in lower extremity strength at 18 months compared to F&S!. Implications for the translation of evidence-based programs into community settings to support healthy behaviors in older adults are discussed.

Feasibility and impact of Fit & Strong! Program in Portuguese older adults with osteoarthritis: A pilot randomized controlled trial.

This pilot study used a small randomized trial to examine the feasibility and the impact of an 8-week multicomponent program among Portuguese older adults with osteoarthritis. Participants were identified from the electronic registers from three primary healthcare centers. Thirty-one older adults (50+ years) with osteoarthritis were randomly assigned to experimental (n= 23) and control conditions (n= 8). Acceptance, attendance and retention rates were measured. The effect of the program on physical performance, osteoarthritis symptomatology (pain and stiffness), functionality, physical activity, depression, anxiety and fear of movement were assessed at baseline, posttest, and 4-months. The acceptance rate was 34%, and 90.4% attended all sessions of the program. The posttest retention rate in experimental group was 69.6% and 100% in control group. Findings demonstrated benefits of the Program on physical performance, function, anxiety, and fear of movement among participants. In the future, it will be important to improve the acceptance rate, however, the high attendance rate and observed effects indicate that the program is an attractive and effective intervention for Portuguese older adults with osteoarthritis.

Comparison of two health-promotion programs for older workers.

OBJECTIVES: We examined the effects of 2 worksite health-promotion interventions (compared with a health-education control) on older workers' healthy behaviors and health outcomes. METHODS: We conducted a prospective, randomized controlled trial with 423 participants aged 40 years and older. Participants were categorized into 3 study arms: the COACH intervention combined Web-based risk assessments with personal coaching support, the RealAge intervention used a Web-based risk assessment and behavior-specific modules, and a control group received printed health-promotion materials. Participants were assessed at baseline, 6 months, and 12 months. Random-effects modeling controlled for baseline stage of change for all behaviors of interest in all groups. RESULTS: At 6 and 12 months, COACH participants showed significantly increased fruit and vegetable consumption (P = .026; P < .001) and participation in physical activity (P = .05; P = .013), and at 12 months they showed decreased percentage of energy from fat (P = .027). RealAge participants showed significantly decreased waist circumference at 6 and 12 months (P = .05; P = .018). CONCLUSIONS: COACH participants were twice as likely to use the COACH intervention as RealAge participants were to use the RealAge intervention. COACH participants experienced twice the number of positive outcomes that control participants experienced.

Participation in a randomised controlled trial for older adults with osteoarthritis in Portugal: Analysis of the acceptance factors.

Fit & Strong! is an evidence-based program that combines exercise with health education for older adults with lower extremity osteoarthritis. This paper explores the factors of acceptance to a randomised controlled trial that tested the Portuguese (Europe) version of Fit & Strong! and analysed the sociodemographic, lifestyle and health characteristics of people who agreed versus people who declined to participate. Patients were identified by General Practitioners at three healthcare centres during 4 months (May 2017 to July 2017). Patients who accepted the invitation and met the inclusion criteria are designated participants, and people who met the inclusion criteria, declined the opportunity to participate but agreed to answer a brief questionnaire are designated as non-participants. Data included sociodemographic, lifestyle behaviours, health, pain and ADLs from the Western Ontario and McMaster Universities Osteoarthritis. Data were analysed using descriptive analysis and the Wilcoxon-Mann-Whitney, Chi-Squared tests or Fisher's tests. The results showed that three out of 12 (25%) primary healthcare centres contacted about the new program accepted the invitation to participate in recruitment. Eighty-two patients were contacted, of whom 14 (17.2%) did not meet inclusion criteria and 32 (38.3%) met the inclusion criteria but declined to participate. The acceptance rate was 22%. Non-participants were older (U = 41.0; W = 212.0; p = .044) and experienced earlier osteoarthritis onset than participants (U = 26.0; W = 146.0; p = .031). In conclusion, younger age and a diagnosis of osteoarthritis more recent appear to predispose older adults with osteoarthritis to be more accepting of participation in a non-pharmacologic intervention designed to increase physical activity.

¡Ojo! What to expect in recruiting and retaining older Latinos in physical activity programs.

Older Latinos are the fastest growing cohort among older adults in the USA, and their lives are often fraught with comorbidities, such as diabetes and obesity. Strong evidence has demonstrated health benefits of regular physical activity for older adults. In spite of this, older Latinos participate in low levels of physical activity. Interventions designed to increase the physical activity of older Latinos are lacking, yet more are emerging as the number of older Latinos grows. Unfortunately, older Latinos face many impediments to participating in physical activity interventions that researchers are unaware of. The purpose of the current article was to identify barriers that researchers are likely to face in conducting physical activity interventions for older Latinos, highlighting recently identified barriers, and providing barriers we encountered specifically with older Latino adults; and strategies to overcome these barriers to implementation.

Fit & Strong! Plus Trial Outcomes for Obese Older Adults with Osteoarthritis.

BACKGROUND AND OBJECTIVES: We compared the effectiveness of standard Fit & Strong! (F&S!; targets physical activity [PA]) to Fit & Strong! Plus (F&S! Plus; targets PA and dietary weight loss) on weight, diet quality, and PA outcomes. RESEARCH DESIGN AND METHODS: We randomly assigned 413 overweight older adults with OA to the F&S! or F&S! Plus programs and assessed outcomes at 2 and 6 months. RESULTS: The F&S! Plus group lost -2.0 ± 0.2 kg (mean ± SE, 2% of starting weight) at 2 months that was maintained at 6 months. Two- and 6-month BMI and waist circumference improved significantly in the F&S! Plus group (p < .001). Diet quality at 2 months showed greater improvement in the F&S! Plus group: 4.6 ± 0.7 versus 2.0 ± 0.7, p = .006, with no significant difference between groups at 6 months. The F&S! Plus group differentially improved on PA engagement at 2 months and at 2 and 6 months in joint pain (6-month mean ± SE: -1.5 ± 0.3 vs -0.6 ± 0.3, p = .02), function (-4.7 ± 0.9 vs -1.5 ± 0.9, p = .01), and 6-min walk test (29.5 ± 5.1 m vs 14.1 ± 5.2 m, p = .04). DISCUSSION AND IMPLICATIONS: Adding a dietary weight loss component to F&S! achieved weight and waist circumference benefits that were maintained at 6 months. Importantly, the weight loss was accompanied by clinically meaningful improvements in OA symptoms and mobility. Future work should investigate minimum thresholds for weight reduction that improve long-term function in this population.

Best-practice physical activity programs for older adults: findings from the national impact study.

OBJECTIVES: We assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes. METHODS: We used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program. RESULTS: For adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01). CONCLUSIONS: Best-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs.

Cultural adaptation and specifics of the Fit & Strong! program in Portugal.

Fit & Strong! is a physical activity/behavior change evidence-based intervention for persons with osteoarthritis (OA) that was developed and tested in USA. This article describes the development of a new culturally adapted Portuguese version of Fit & Strong!, reviews the methods used, and describes the new features of the Portuguese program. Six steps were implemented for the cultural adaptation: training the Portuguese research team, materials translation, needs assessment which includes literature review, focus group with older adults with lower extremity joint pain, interviews with experts about Fit & Strong! format and content, program instructor training, and pilot study and program implementation. At the conclusion of the pilot, debriefing interviews were held with participants and instructors to obtain their opinions about the program. Thematic content analysis and SWOT analysis were used to analyze the qualitative data. Findings indicated needed changes to the original Fit & Strong! program protocol. In the Manuals, language was simplified and more pictures added to be suitable for people with lower level of literacy. Also, practical examples described in Manuals were adjusted or substituted to better fit the Portuguese culture. As a description of Portuguese organizations in the field, Thermal Spa and Mediterranean diet were added to the Manual. We recommend using two instructors to address individual challenges during the sessions. The Portuguese version of Fit & Strong! introduces all the necessary changes to become a relevant new intervention program to raise quality of life of patients with OA in Portugal.

Cognitive-motor exergaming for reducing fall risk in people with chronic stroke: A randomized controlled trial.

BACKGROUND: Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE: We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS: Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS: Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION: Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings.

Associations between Alternate Healthy Eating Index-2010, Body Composition, Osteoarthritis Severity, and Interleukin-6 in Older Overweight and Obese African American Females with Self-Reported Osteoarthritis.

Osteoarthritis (OA) is a leading cause of immobility in the United States and is associated with older age, inflammation, and obesity. Prudent dietary patterns have been associated with disease prevention, yet little evidence exists describing diet quality (DQ) in older overweight or obese African American (AA) adults with OA and its relation to body composition. We conducted a secondary data analysis of a dataset containing alternate Healthy Eating Index-2010 (AHEI-2010), body composition, OA severity, and serum interleukin-6 (IL-6) data from 126 AA females (aged 60⁻87 years) with OA to examine the relationships between these variables. Our sample had poor DQ and reported having higher OA severity as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Interleukin-6 was negatively correlated with AHEI-2010, and AHEI-2010 and the WOMAC physical function subcategory (WOMACpf) were significant predictors of IL-6 (odds ratio (OR): 0.95, 95% confidence interval (CI) 0.92⁻0.99 and 1.04, 95% CI 1.01⁻1.07, respectively, p < 0.05) but not body composition. In conclusion, AHEI-2010 and WOMACpf were significant predictors of inflammation (IL-6) and AHEI-2010 accounted for ~16% of the variation of IL-6 (inflammation) in this sample.

Health and Lifestyles Factors Associated With Osteoarthritis among Older Adults in Portugal.

OBJECTIVE: This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health, and osteoarthritis (OA), among older adults. METHODS: A sample of 1,645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population-based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease, and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. OA (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria. RESULTS: 1,059 participants (64.9%) met the OA classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression, and anxiety. In the unadjusted logistic regression models, all variables were associated with OA. The final adjusted model explained 32% of the variance. Those who are female with higher age, have more than five comorbidities, and lower levels of function and physical activity were more likely to meet the criteria for a diagnosis of OA. DISCUSSION: We have analyzed data from a population-based study and found that a diagnosis of OA was independently associated with age, female gender, higher number of comorbidities, physical disability, and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.

Translating Strong for Life Into the Community Care Program: Lessons Learned.

We used a randomized controlled trial to test the implementation of Strong for Life (SFL), a resistance exercise intervention, using 32 home care aides (HCAs) as exercise leaders with their 42 homebound older adult clients enrolled in the Community Care Program, a Medicaid 1915(c) waiver program. Mixed-methods were used to analyze outcomes of program satisfaction rates, training session evaluations, program fidelity, and job descriptive index scores. Results indicate that it is feasible for HCAs to implement SFL safely with clients. Participants viewed SFL as highly satisfactory and HCAs were able to adapt SFL for their clients. HCAs have high job satisfaction, and leading SFL enhances work achievement and pride. Our results show it is possible to train HCAs to implement SFL with their clients in addition to providing usual care services, participation positively affects both care partners, and this is a feasible and practical delivery model to provide exercise for adults receiving home- and community-based services.

Long-term impact of Fit and Strong! on older adults with osteoarthritis.

PURPOSE: We present final outcomes from the multiple-component Fit and Strong! intervention for older adults with lower extremity osteoarthritis. DESIGN AND METHODS: A randomized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement (n=115) with a wait list control (n=100) at 2, 6, and 12 months. Fit and Strong! combined flexibility, aerobic walking, and resistance training with education and group problem solving to enhance self-efficacy for exercise and maintenance of physical activity. All participants developed individualized plans for long-term maintenance. RESULTS: Relative to controls, treatment participants experienced statistically significant improvements in self-efficacy for exercise (p=.001), minutes of exercise per week (p=.000), and lower extremity stiffness (p=.018) at 2 months. These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time (p=.001), reduced pain (p=.040), and a marginally significant increase in self-efficacy for arthritis pain management (p=.052). Despite a substantially smaller sample size at 12 months, significant treatment-group effects were maintained on self-efficacy for exercise (p=.006) and minutes of exercise per week (p=.001), accompanied by marginally significant reductions in lower extremity stiffness (p=.056) and pain (p=.066). No adverse health effects were seen. Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713, and 0.905 and 0.669, respectively, in the treatment group at 6 and 12 months. IMPLICATIONS: This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis.

Characteristics of physical activity programs for older adults: results of a multisite survey.

PURPOSE: Although increased participation in physical activity by older adults is a major public health goal, little is known about the supply and use of physical activity programs in the United States. DESIGN AND METHODS: Seven academic centers in diverse geographic areas surveyed physical activity programs for older adults. Five sites conducted surveys by mail with telephone follow-up, and two administered surveys primarily by telephone. Reported program attendance rates were compared with local census data to assess unmet needs. RESULTS: Of the 2,110 targeted facilities, 77% responded. Aerobic programs were offered by 73%, flexibility by 47%, and strength training by 26%. Commercial gyms or YMCAs, senior centers, park or recreation centers, and senior-housing facilities offered 90% of available programs. The 2000 Census enumerated 1,123,401 total older adults across the seven sites. Facilities reported 69,634 individuals as current weekly program participants, equaling 6% of the sites' total older-adult population. This percentage varied from 3% in Pittsburgh to 28% in Colorado. IMPLICATIONS: Based on conservative estimates of demand, the number of physical activity programs would have to increase substantially (by 78%) to meet the needs of older adults. The data also indicate the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs. There is a clear need to stimulate demand for programs through health promotion.

Performance measures, hours of caregiving assistance, and risk of adverse care outcomes among older adult users of Medicaid home and community-based services.

OBJECTIVES: This study used validated physical performance measures to examine function, risk of adverse health outcomes, and the relationship with allocated hours of weekly caregiving assistance among older adults receiving home and community-based services through a Medicaid waiver program. METHODS: Older adults (n = 42) completed physical performance measures including grip strength, 30-s chair rise, Timed Up and Go, and gait speed. Demographic information including age, gender, and allocated hours of weekly caregiving assistance were also collected. RESULTS: A majority, 72% of females and 86% of males, had weak grip strength, 57% met criteria for fall risk based on their Timed Up and Go score, 83% had lower extremity strength impairments, and 98% were unable to ambulate more than 1.0 m/s. Frailty was prevalent in the sample with 72% of clients meeting Fried's frailty criteria. The most significant predictors of allocated hours of weekly caregiving assistance approved for clients were race and gait speed. CONCLUSION: Based on scores on physical performance measures, clients are at risk of falls, hospitalization, and mortality, and scores indicate an urgent need to assess performance in addition to self-reported activities of daily living limitations for this population. Performance measures associated with quantifiable risk of adverse outcomes can be critical indicators for referrals and services needed to enhance the safety and improve care outcomes for homebound older adults.

Impact of Cognitive Training on Balance and Gait in Older Adults.

OBJECTIVES: Cognitive processing plays an important role in balance and gait and is a contributing factor to falls in older adults. This relationship may be explained by the fact that higher order cognitive functions such as executive functions are called upon while walking. The purpose of this study was to examine whether a cognitive training intervention leads to significant improvements on measures of balance and gait. METHOD: This randomized trial tested whether cognitive training over 10 weeks improves balance and gait in older adults. Participants were randomly assigned to a computer-based cognitive training intervention or measurement-only control. Outcomes included Timed Up and Go (TUG), gait speed, and gait speed with a cognitive distraction. Data were analyzed using analysis of covariance models with change scores. RESULTS: Participants' (N = 51) average age was 82.7 for those randomized to intervention and 81.1 for those randomized to control. After 10 weeks, intervention group participants performed significantly better than controls on the TUG. When the cohort was limited to those categorized as slow walkers (baseline 10-m walk ≥ 9 s), intervention participants performed significantly better than controls on TUG and distracted walking. DISCUSSION: Cognitive training slows degradation of balance and improves gait while distracted, rendering it a promising approach to falls prevention.

Comparison of two home care protocols for total joint replacement.

OBJECTIVES: To examine the effect of a more-efficient home care protocol to manage total joint replacement (TJR) patients after surgery. DESIGN: A randomized trial of two home care protocols for TJR management. SETTING: A hospital-affiliated home healthcare agency in a large midwestern city. PARTICIPANTS: Medicare-eligible individuals undergoing elective total hip or knee replacement surgery (N = 136). INTERVENTION: A home care protocol that included preoperative home visits by a nurse and a physical therapist and fewer postoperative visits (range of 9-12 visits) to the home than an existing protocol (range of 11-47 visits). MEASUREMENTS: Functional status, lower extremity functioning, health-related quality of life, satisfaction with care, and use and cost of healthcare services for 6 months postsurgery. RESULTS: There were no differences in functional status, health-related quality of life, or lower extremity functioning by group at 6 months. A marginally significant gain in satisfaction with access to care (P =.059) was found in the intervention group at 6 months. Home healthcare costs were 55% lower for the streamlined group (P <.001). Other costs did not differ significantly by group. CONCLUSION: TJR patients who received the more-efficient home care protocol experienced comparable outcomes to those who received the existing protocol. An abbreviated set of home care visits resulted in more-efficient delivery of care without compromising patient outcomes.

Impact of the fit and strong intervention on older adults with osteoarthritis.

PURPOSE: This study assessed the impact of a low cost, multicomponent physical activity intervention for older adults with lower extremity osteoarthritis. DESIGN AND METHODS: A randomized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence (n = 80) to a wait list control group (n = 70). Assessments were conducted at baseline and at 2 and 6 months following randomization. The training program consisted of range of motion, resistance training, aerobic walking, and education-group problem solving regarding self-efficacy for exercise and exercise adherence. All training group participants developed individualized plans for posttraining adherence. RESULTS: Relative to the persons in the control group, individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy, a 48.5% increase in exercise adherence, and a 13.3% increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months. Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months (p =.052). In contrast, persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures. No adverse health effects were encountered. IMPLICATIONS: These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis.

Evaluation of the managed community care demonstration project.

The purpose of this article is to describe the impact of a capitated community-care demonstration in Illinois that attempted to increase the range of services provided while constraining overall costs. The authors examined the implementation and outcomes, using pretest and posttest measures of client satisfaction, range of services, agency costs, and nursing home admissions. Demonstration clients (n = 752) had a mean age of 80, and an average of two activities of daily living impairments. The number of covered services increased from 3 at baseline to 14 during the demonstration, whereas the mean number of services used increased from 1 to 2.5. Satisfaction with care remained stable and agency average costs declined. The capitation rate more closely approximated agency costs than customary fee-for-service (FFS) and provided a fixed deductible for clients. No difference was seen in nursing home admissions compared to clients served under FFS in the same geographic location. These results imply that capitation increased the range of covered services, maintained client satisfaction, increased efficiency, and did not affect rate of nursing home admissions. Capitated home- and community-based services needs to be tested in other locations and with other providers.

A randomized trial to measure the impact of a community-based cognitive training intervention on balance and gait in cognitively intact Black older adults.

INTRODUCTION: Fall prevention is important for maintaining mobility and independence into old age. Approaches for reducing falls include exercise, tai chi, and home modifications; however, causes of falling are multifactorial and include not just physical but cognitive factors. Cognitive decline occurs with age, but older adults with the greatest declines in executive function experience more falls. The purpose of this study was twofold: to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population. METHOD: This pilot study used a pretest/posttest randomized trial design with assignment to an intervention or control group. Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks. Classes were held at senior/community centers. Primary outcomes included balance as measured by the Berg Balance Scale (BBS), 10-meter gait speed, and 10-meter gait speed under visuospatial dual-task condition. All measures were assessed at baseline and immediately post-intervention. RESULTS: Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls (N = 45). Compared to controls, intervention participants experienced statistically significant improvements in BBS and gait speed. Mean performance on distracted gait speed also improved more for intervention participants compared to controls. CONCLUSION: Findings from this pilot randomized trial demonstrate the feasibility of a community-based cognitive training intervention. They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls.