Introduction

As people age, staying active becomes one of the most important ways to maintain health, mobility, and independence. The World Health Organization (2023) highlights physical activity as a cornerstone of healthy aging, supporting not only physical function but also cognition and overall well-being. However, with age comes a natural decline in muscle strength and neuromotor control, especially in the ankles, leading to greater variability in walking patterns. These changes often increase the risk of imbalance and fall, one of the most common causes of injury and loss of independence among older adults. In physiotherapy, understanding how exercise interventions influence walking ability is essential. Regular, well designed physical activity programs can improve balance, coordination, and confidence in movement, helping older adults maintain autonomy in daily life.

Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 44 in 2025, we had International Course in Spain, A Coruna, in the Faculty of Physiotherapy at University of Coruña about EBP. The program was opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields. More than 30 physiotherapy students and 9 teachers from six universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Czech Republic, CERRFF and École D´Assas, France, and Escola de Santa María de O Porto, Portugal), actively participated this week and shared experiential group dynamics and social activities. The students collaborated and wrote articles on a range of topics, including evidence-based neurology, respiratory and musculoskeletal disorders, geriatric and pediatric care, as well as sports injuries and related issues. This blog article is based on a mini literature review examining how exercise training affects walking ability in the elderly.

Methods

A systematic review was conducted to examine randomized controlled trials (RCTs) investigating the effects of physical activity on mobility, cognitive function, and overall physical fitness among healthy older adults. A comprehensive search of the PubMed database was performed using the keywords physical activity, exercise, and gait, covering publications from 2015 to 2025. Studies included if they met the following criteria: (1) participants were healthy older adults without major comorbidities; (2) the intervention involved structured exercise or physical activity; and (3) outcomes included measures of physical or cognitive performance. Data extraction focused on participant characteristics, intervention type and duration, outcome measures, and key findings. The methodological quality of the included trials was evaluated using the Physiotherapy Evidence Database (PEDro) scale to ensure the reliability and validity of the evidence. Following the selection process, three RCTs met the inclusion criteria and were included in the final review: Raichlen et al. (2020, USA), Wang et al. (2024, China), and Galle et al. (2023, Netherlands).

Results

Three randomized controlled trials met the inclusion criteria and provided evidence on the effects of various forms of physical activity on mobility, balance, and cognitive function in healthy older adults.

Raichlen et al. (2020) examined the impact of a combined aerobic and cognitive training program. Participants who engaged in both types of training exhibited significantly greater improvements in cognitive performance, particularly in memory and executive function domains, compared with those who performed aerobic exercise alone. Notably, these cognitive benefits emerged as early as six weeks into the intervention.

Wang et al. (2024) compared the effects of aerobic exercise with a combined aerobic–resistance training regimen. Both intervention groups demonstrated significant gains in muscle strength and postural balance; however, participants in the combined training group additionally exhibited faster gait speed and enhanced dynamic stability. These findings indicate that incorporating resistance training may facilitate safer and more efficient movement among older adults.

Galle et al. (2023) implemented a lifestyle-based intervention that promoted increased daily walking through personalized counseling. Although no significant changes in overall cognitive or fitness measures were observed across the entire cohort, participants who increased their daily step count by more than one-third demonstrated meaningful improvements in both physical and cognitive outcomes.

Collectively, the findings from these studies highlight the positive effects of regular physical activity on mobility, balance, and cognitive health in older adults. Interventions that integrate both physical and cognitive components appear to yield the most substantial and comprehensive benefits, underscoring the value of engaging both body and mind in exercise programs for healthy aging.

PEDro scale

Across the three included studies, methodological quality assessed using the PEDro scale was moderate, with all studies scoring 6/10. All trials clearly reported eligibility criteria, used random allocation, and had groups comparable at baseline. However, none of the studies implemented concealed allocation, and blinding was largely absent particularly for subjects and therapists while only one study included blinded assessors. All studies maintained acceptable dropout rates (<15%) and reported between-group comparisons, with two of the three studies performing an intention-to-treat analysis. Overall, the consistency in scoring reflects adequate methodological rigor, but highlights common limitations in blinding procedures across the included research.

Conclusion

Exercise plays a vital role in maintaining independence and well-being in older adults. Whether through walking, resistance training, or activities that also challenge the mind, regular movement supports strength, balance, and cognitive function.

For physiotherapists, these findings highlight the importance of integrating tailored, evidence-based exercise programs into the rehabilitation and prevention plans of older clients. Encouraging even small increases in daily activity can have meaningful long-term benefits.

While current research provides promising results, more studies are needed to determine the optimal “dose” of exercise—how often, how long, and at what intensity—to achieve the best outcomes. Exploring combined physical and cognitive approaches, as well as home-based and digital formats, could make exercise more accessible and sustainable for older adults worldwide.

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Authors:

Aubin Ayivi, physiotherapy student, Ecole d’Assas – Formation en Rééducation et Santé

Sonja Lydman, physiotherapy student, Savonia University of Applied Sciences

Louiza Maria Theofanous, physiotherapy student, Charles University faculty of Physical Education and Sports

Dagmar Pavlu, PT. Assoc. Prof. Charles University, Czech Republic.

Ivana Vláčilová, PhD., PT. Charles University, Czech Republic.

Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland.

Veronica Robles García, PhD. PT. OT. Associate Professor, University of A Coruña, A Coruña, Spain.

Zeltia Naia Entonado, PhD. PT. University of A Coruña, A Coruña, Spain.

María Vilanova Pereira, PhD., PT. University of A Coruña, A Coruña, Spain.

Adrien Pallot, PT, MSc, Lecturer at École D´Assas, France.

Aurel Bellaïche, PT, Lecturer at CEERRF, France.

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References:

Galle, S. A., Deijen, J. B., Milders, M. V., De Greef, M. H. G., Scherder, E. J. A., van Duijn, C. M., & Drent, M. L. (2023). The effects of a moderate physical activity intervention on physical fitness and cognition in healthy elderly with low levels of physical activity: a randomized controlled trial. Alzheimer’s Research & Therapy, 15(1), 12. https://doi.org/10.1186/s13195-022-01123-3

Gamwell, J., Reznick, J. S., Jordan, K., & Stergiou, N. (2022). Aging and gait function: Examination of multiple factors that influence gait variability. Frontiers in Aging Neuroscience, 14, 825927. https://doi.org/10.3389/fnagi.2022.825927

Raichlen, D. A., Bharadwaj, P. K., Nguyen, L. A., Franchetti, M. K., Zigman, E. K., Solorio, A. R., & Alexander, G. E. (2020). Effects of simultaneous cognitive and aerobic exercise training on dual-task walking performance in healthy older adults: Results from a pilot randomized controlled trial. BMC Geriatrics, 20(1), 83. https://doi.org/10.1186/s12877-020-1484-5

Wang, W., Liu, X., Zhang, X., Song, T., Gao, B., Ding, D., & Yan, Z. (2024). Effects of aerobic and combined aerobic–resistance exercise on motor function in sedentary older adults: A randomized clinical trial. Journal of Back and Musculoskeletal Rehabilitation, 37(1), 25–36. https://doi.org/10.3233/BMR-220414

World Health Organization (WHO). (2023). Promoting physical activity and healthy diets for healthy ageing in the WHO European Region. https://www.who.int/europe/publications/i/item/WHO-EURO-2023-8002-47770-70520

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