Tobacco Use and Recovery of Gait and Balance Function in Older Adults

Objective: To examine the influence of tobacco use status on outcome after an exercise program designed to improve gait and balance. Design: Review of clinical database. Setting: Standardized assessment clinic in a tertiary care setting. Participants: Patients (N=136, 77.2+/-5.8y, 3 women) who were attending a Gait and Balance Disorders clinic. Interventions: Individualized home exercise programs based on findings of an extensive gait and mobility examination. Patients were evaluated every 4 weeks for 12 weeks. Main Outcome Measures: Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Medical Outcomes Study 36-item Short Form Health Survey Physical Functioning subscale (SF-36 PF). Differences were assessed preintervention, and separate hierarchical linear regression models were used to examine the unique contribution of tobacco use to changes in each of primary outcome measures. Results: Current tobacco users had higher frequencies of chronic obstructive pulmonary disease (P=.009) and depression (0.037). No differences were noted on preintervention measures of the primary outcomes based on tobacco use. Tobacco use explained a significant amount of additional variance in the postintervention score on each of the primary outcomes (BBS, 25.4%; DGI, 8.7%; SF-36 PF, 30.3%) after controlling for preintervention score, depression, and limb strength. Inspection of the adjusted means indicated that the group that had never used tobacco showed greater improvement than the current users for all variables after adjusting for factors used in the regression models. Conclusions: Older adults who never used tobacco showed greater improvement than the current users for all variables after adjusting for factors used in the regression models. Current tobacco users perceived themselves to be more limited by their health after participation in the rehabilitation exercise program.