Does an Innovative PT Program Targeting Mobility Benefit Veterans With Executive Function Deficit?

People with executive function problems may respond differently to physical therapy (PT) treatment than those without executive function problems. We examined the treatment response of a novel PT treatment known as Live Long Walk Strong (LLWS).

This study was a preplanned secondary analysis of a randomized controlled trial among middle- and older-aged Veterans (≥ 50 years) with slow walking speed. Veterans with and without executive function deficits (EFD+/EFD-) received 8 weeks of LLWS care. Changes after treatment in mobility (Short Physical Performance Battery (SPPB), walking speed, Activity Measure for Post-Acute Care) and executive function (Delis-Kaplan Executive Function System Verbal Fluency (letter fluency, category fluency, category switching)) were evaluated according to baseline EFD status using mixed linear regression models.

Veterans who completed the 8 week LLWS treatment (N = 103) were included in this study (mean age 71), and 15% (n = 15) were EFD+. Both mobility and executive function measures were significantly lower among participants with EFD+ at all timepoints (p < 0.05). Participants showed statistically and clinically significant improvements across all mobility outcomes over time (p < 0.05), with no significant interaction by time and EFD status (p > 0.40). Statistically significant improvement was observed only in letter fluency (p = 0.02) among the executive function measures. However, we observed statistically significant time by EFD status interactions for category switching fluency (p < 0.05), favoring the EFD+ groups. Overall, participants with EFD had greater improvement in executive function compared to participants without EFD (mean composite z-score increase of 0.38 SD units vs. 0.003 SD units, respectively).

LLWS treatment appears efficacious for improving mobility in individuals with and without EFD. LLWS treatment may also benefit aspects of executive function, particularly for Veterans with deficits in these cognitive domains. Future investigation of these questions within larger and more diverse cohorts is warranted.