Live Long Walk Strong (LLWS) Rehabilitation Program: What Features Improve Mobility Skills (LLWS)

The Live Long Walk Strong Rehabilitation Program: What Features Improve Mobility Skills?

This study was performed to evaluate the efficacy of the Live Long Walk Strong rehabilitation program in Veterans 50 years and older. This study will examine the features of the program that contribute to improved gait speed.

Study Overview

• Status: Completed
• Conditions: Mobility Limitation
• Intervention / Treatment: Other: Live Long Walk Strong rehabilitation program

Detailed Description

This study was a 4 year phase II randomized clinical trial study design. This study will provide important information about the mechanisms that contribute to meaningful improvement in mobility, the benefits of a novel mode of physical therapy care, and the duration of treatment effect.

This study addresses Veterans with slow gait speed beginning in midlife. Slow walking speed is a major health concern for aging Veterans, that independent of disease status, predicts adverse health outcomes. Physical therapy (PT) care is the foundational treatment for slow gait speed, but no standard treatment approach exists. Clinically feasible modes of PT care that provide longer term improvements in gait speed are not established. The investigators developed Live Long Walk Strong , which is a clinically feasible program of PT care that builds upon research identifying novel modes of treatment with greater efficacy than standard care. The investigators have shown proof of concept among civilians and must confirm this among Veterans across a broader age range than was studied previously. Also, it is critical that the investigators define the attributes targeted by which LLWS induces gait speed improvements, not only after treatment ends but after 16 weeks of subsequent follow up. If successful, it will lead to LLWS refinements, establishing it as a rigorously tested model of PT care, that can be implemented across the VHA nationally.

• Study Type: Interventional
• Enrollment (Actual): 151
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02130-4817
      • VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Veteran
• Aged 50 and older
• Community dwelling
• Ability to speak and understand English
• Usual gait speed 0.5 m/s- 1.0 m/s Activity modifications and access to telehealth rehabilitation

Exclusion Criteria:

• Presence of a terminal disease
• A major medical problem, unstable chronic condition, or psychiatric disorder that interferes with safe and successful testing and training
• Myocardial infarction or major surgery in previous 3 months
• Planned major surgery
• Baseline short physical performance battery score less than 4
• Use of a walker
• Modified mini mental status examination score less than or equal to 77

• Presence of a significant disease specific impairment such as:

  • peripheral neurologic impairment
  • orthopedic impairment
  • visual impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Live Long Walk Strong; 8 week rehabilitation program	Other: Live Long Walk Strong rehabilitation program; Live Long Walk Strong is a rehabilitation program that focuses on impairments known to contribute to mobility decline that are not considered standard of care in rehab and addresses behavioral change within the context of rehabilitation.
Active Comparator: 8 week wait list control; 8 week wait list then followed by 8 weeks of the Live Long Walk Strong rehabilitation program	Other: Live Long Walk Strong rehabilitation program; Live Long Walk Strong is a rehabilitation program that focuses on impairments known to contribute to mobility decline that are not considered standard of care in rehab and addresses behavioral change within the context of rehabilitation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Walking Speed	Walking (gait) speed is assessed as usual walking pace over a 4-meter course.	Randomization to 8 weeks (comparing intervention to wait list)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lower Extremity Power	Lower extremity power measure will be assessed via the modified stair climb test.	Randomization to 8 weeks (comparing intervention to wait list groups)
Trunk Muscle Endurance	Trunk muscle endurance will be assessed via saunders table through time (seconds) held in a fixed position of trunk extension. Position is held up to 2 minutes and 30 seconds (150 seconds total). The data presented is normalized by body weight.	Randomization to 8 weeks (comparing intervention to wait list groups)
Gait Variability	Gait variability will be assessed via zeno gait mat measurement of step length, step width and other measures of gait quality captured via the pkmas software within the zeno gait mat. Gait variability is reported as the standard deviation of stance time variability (SD), the standard deviation of stance time standard deviation. This measures the variability of static position within the gait cycle.	Randomization to 8 weeks (comparing intervention to wait list groups)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cognition - Delis-Kaplan Executive Function Systems (DKEFS) Verbal Fluency	A cognitive battery, including the DKEFS verbal fluency will be assessed pre and post intervention (within 2 weeks). Raw scores are used for each sub-test. The mean change in the raw score over the 8 weeks is reported.; Verbal Fluency: Letter Fluency total subscale score 6-83, with higher scores indicating a better outcome.; Verbal Fluency: Category Fluency total subscale score 17-63, with higher scores indicating a better outcome.; Verbal Fluency: Category Switching total subscale score 2-20, with higher scores indicating a better outcome.; Verbal Fluency: Category Switching total subscale score 1-21, with higher scores indicating a better outcome.	Randomization to 8 weeks (comparing intervention to wait list groups)
Cognition- DKEFS Trail Making Test	The DKEFS Trail Making Test used conditions 2 and 4. Time to complete was used to calculate the mean change over the 8-weeks. Mean change in time to complete each condition are reported.	Randomization to 8 weeks (comparing intervention to wait list)
Adherence	Adherence will be assessed by drop out status during the intervention period for each group respectively. This will be scored as a yes or no variable.	Intervention Period (8-weeks)
Compliance	Compliance with be assessed by the number of intervention sessions attended (out of 10).	Intervention Period (8-weeks)

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Jonathan F. Bean, MD, VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Publications and helpful links

General Publications

• Wingood M, Linsky AM, Harris R, Bamonti P, Moye J, Bean JF. Research Protocol Adaptations During the COVID-19 Pandemic: A Process Evaluation. J Aging Phys Act. 2023 Sep 12;32(1):62-68. doi: 10.1123/japa.2023-0052. Print 2024 Feb 1.
• Harris R, Brach JS, Moye J, Ogawa E, Ward R, Halasz I, Bean J. The Live Long Walk Strong Rehabilitation Program Study: Design and Methods. Arch Rehabil Res Clin Transl. 2022 May 29;4(3):100205. doi: 10.1016/j.arrct.2022.100205. eCollection 2022 Sep.
• Bamonti PM, Moye J, Harris R, Kallmi S, Kelly CA, Middleton A, Bean JF. Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy. Arch Rehabil Res Clin Transl. 2022 Apr 21;4(2):100198. doi: 10.1016/j.arrct.2022.100198. eCollection 2022 Jun.
• Harris R, Ogawa EF, Ward RE, Fitzelle-Jones E, Travison T, Brach JS, Bean JF. Feasibility and Preliminary Efficacy of Virtual Rehabilitation for Middle and Older Aged Veterans With Mobility Limitations: A Pilot Study. Arch Rehabil Res Clin Transl. 2024 Feb 12;6(2):100325. doi: 10.1016/j.arrct.2024.100325. eCollection 2024 Jun.
• Ogawa EF, Harris R, Moye J, Bean JF, Kim B. Veterans' Motivation, Preference, and Feedback After Completing a Novel Physical Therapy Treatment. J Aging Phys Act. 2025 Jan 17;33(4):379-386. doi: 10.1123/japa.2023-0446. Print 2025 Aug 1.

Study record dates

Study Major Dates

• Study Start (Actual): January 21, 2021
• Primary Completion (Actual): September 30, 2024
• Study Completion (Actual): November 7, 2024

Study Registration Dates

• First Submitted: July 18, 2019
• First Submitted That Met QC Criteria: July 18, 2019
• First Posted (Actual): July 19, 2019

Study Record Updates

• Last Update Posted (Actual): February 20, 2026
• Last Update Submitted That Met QC Criteria: February 2, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Aging; Mobility Skills
• Additional Relevant MeSH Terms: Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Mobility Limitation
• Other Study ID Numbers: E3095-R

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No