February, 2023

Salbach NM, Barclay R, Webber SC, Jones CA, Mayo N, Lix LM, Ripat J, Grant T, van Ineveld C, Chilibeck PD.

University of British Columbia Okanagan

Take home message

  • A 1-day educational workshop followed by a 10-week (2 1-hour sessions/week) park-based outdoor walking program (GO-OUT), is superior to the same workshop and 10 weekly telephone reminders (WR) in improving walking capacity in older adults (age 65+ years) who infrequently walk outdoors.
  • Increased walking capacity was defined as any improvement in balance, leg strength, walking speed, walking endurance, or walking confidence.
  • The GO-OUT program was not superior to the WR program in improving outdoor walking activity, health-promoting behavior or successful aging.


  • A third of older adults walk outside fewer than 3 days a week.
  • Infrequent outdoor walking is an indicator of frailty, social isolation, reduced health-related quality of life and can increase the risk of mobility and self-care decline.
  • Physical factors (decreased fitness, balance and leg strength), psychological factors (fear of moving outdoors and decreased confidence in community mobility) and environmental barriers (poor social support, scheduling, cost, transportation, walking distance to destination, crowds, traffic, outdoor terrain and safety) limit outdoor walking for older adults.
  • A workshop and park-based outdoor walking program addressing barriers to outdoor walking (GO-OUT) was developed to improve capacity in seven dimensions of community mobility and tested in a pilot study.
  • The aim of the current study was to evaluate the GO-OUT program compared to a workshop and 10 weekly telephone reminders (WR) in a multi-site randomized controlled trial.

How the study was done

  • Older adults with difficulty walking outdoors living in four urban Canadian communities were randomized to either the GO-OUT (n=98) or WR group (n=92).
  • Prior to randomization, all participants were invited to attend a 1-day, interactive educational workshop in which they participated in eight activity stations designed to increase knowledge, confidence, and skill in areas that would promote safe outdoor walking behaviour.
  • Each station was facilitated by a health professional or student in a health-related program (e.g., kinesiology, physical therapy) who had experience working with older adults.
  • After the workshop, participants in the GO-OUT group attended a park-based walking program that involved 1-hour sessions, twice per week for 10 weeks with a ratio of 1 supervisor to 3 participants (maximum 9 per group).
  • Each session included a 10-minute warmup, walking a pre-specified distance that increased over time (10 minutes), task-oriented practice of an outdoor walking skill for 20 minutes (e.g., walking on hills, carrying a load), walking the pre-specified distance again (10 minutes), and a 10-minute cool down.
  • We used accelerometry to measure the walking distances and speeds achieved during the first 10-minute “distance walk” in weeks 3 and 9 of the park-based program in people who attended both times.
  • Of the 98 participants randomized to the park-based walking program, 15% received 0 sessions for various reasons including scheduling, transportation, and ill health; 17% received 1-8 sessions; and 67% received 9-20 sessions.
  • In the WR program (active control group), site coordinators telephoned participants weekly for 10 weeks to review scripted information reminding participants about the information included in the workshop.
  • The primary outcome was the change from baseline to each follow-up timepoint (3 and 5.5 months) in the number of minutes spent walking outdoors, derived from accelerometry and GPS data.
  • Secondary outcomes included change from baseline at 3 and 5.5 months in walking capacity, health-promoting behavior (moderate to vigorous physical activity, life space mobility) and successful aging (participation, emotional well-being, general health).

What the researchers found

  • There was no significant difference in the change in time spent walking outdoors from baseline to 3 and 5.5 months between the GO-OUT and WR groups (median number of minutes (min) of outdoor walking in GO-OUT vs WR group: 0 months: 23 vs 24 min; 3 months: 13 vs 26 min; 5.5 months: 0 vs 0 min).
  • During the first 10-minute walk, the median distance walked increased from 403 metres in week 3 to 478 metres in week 9 and the median walking speed increased from 0.65 metres/second in week 3 to 0.75 metres/second in week 9 of the park-based walking program.
  • There was significantly greater improvement in walking capacity from baseline to 3 months in the GO-OUT group compared to the WR group driven mainly by an improvement in walking confidence.
  • All other comparisons were not statistically significant.
  • Frailty level, sex and number of sessions attended or reminders received did not influence the effect of the interventions on time spent walking outdoors.


  • The park-based outdoor walking program was not superior to telephone weekly reminders in increasing time spent walking outdoors, health-promoting behavior or successful aging in older adults with difficulty walking outdoors. The park-based program was superior to weekly reminders, however, in improving walking capacity immediately after the program.
  • Implementing the GO-OUT program in the community would enable older adults who demonstrate difficulty with outdoor walking to engage in progressively more challenging walking tasks that could build their confidence to walk outdoors.
  • Further studies investigating the response of endurance trained or clinical populations to intermittent hypoxia should be conducted to see if it could be a time-efficient method of naturally increasing EPO as any preexisting impairments may impact the observed responses.


Salbach NM, Barclay R, Webber SC, Jones CA, Mayo N, Lix LM, Ripat J, Grant T, van Ineveld C, Chilibeck PD. A theory-based, task-oriented, outdoor walking programme for older adults with difficulty walking outdoors: protocol for the Getting Older Adults Outdoors (GO-OUT) randomised controlled trial. BMJ Open 2019;9:e029393. Available from: doi:10.1136/bmjopen-2019-029393.