Skip to main content Skip to main navigation menu Skip to site footer

Locomotion training addition to regular aerobic exercise improves walking speed and two-step test of the institutionalized older adult with Locomotive Syndrome stage 1: a randomized controlled trial

  • Michael Prayogo ,
  • Rwahita Satyawati ,
  • Dyah Intania Sari ,
  • Damayanti Tinduh ,
  • Sri Mardjiati Mei Wulan ,
  • Yukio Mikami ,
  • Soenarnatalina Melaniani ,


Background: Most nursing homes in Indonesia use only aerobic exercise as regular exercise for their resident. Locomotion Training is a combination of lower extremity strengthening and balance exercises. This study aims to determine the effects of the addition of locomotion training to regular aerobic exercise on Walking Speed (WS) and Two Step Test (TST) of institutionalized older adults with the locomotive syndrome (LS) stage 1.

Methods: 24 older adults with locomotive syndrome stage 1 (mean age, 73.85 years) participated in the study and were randomly allocated to the Locomotion Training addition group (LTG) and control group (CG). Eight weeks of daily group-based aerobic exercise were conducted for 30 minutes for both groups. The LTG performed additional locomotion training 3 times per week, with a progressive increase of set and repetition at each activity according to the participant's tolerance. The measurement of WS and TST was collected at baseline and 3 days after the intervention was completed for each participant.

Results: Twenty participants completed the study, ten from CG and ten from LTG. The results showed a significant statistical difference in WS and TST in LTG (p <0.05) but no improvement in the CG (p >0.05) after 8 weeks of intervention.

Conclusion: In addition to regular aerobic exercise, Locomotion Training can improve WS and TST in the institutionalized older adult with locomotive syndrome stage 1.


  1. Nakamura K, Ogata T. Locomotive Syndrome: Definition and Management. Clin Rev Bone Miner Metab. Springer US; 2016;14(2):56–67. DOI: 10.1007/s12018-016-9208-2.
  2. Ikemoto T, Arai YC. Locomotive syndrome: Clinical perspectives. Clin Interv Aging. 2018;13:819–27. DOI: 10.2147/CIA.S14868.
  3. Taniguchi M, Ikezoe T, Tsuboyama T, Tabara Y, Matsuda F, Ichihashi N. Prevalence and physical characteristics of locomotive syndrome stages as classified by the new criteria 2020 in older Japanese people: results from the Nagahama study. BMC Geriatr. BMC Geriatrics; 2021;21(1):1–10. DOI: 10.1186/s12877-021-02440-2.
  4. Valentina N, Kurniawati PM, Maramis MM. Correlation of Lower Limb Muscles and Body Mass Index with Body Balance in the Elderly. Folia Medica Indones. 2021;55(1):58. DOI:
  5. Kristiana T, Widajanti N, Satyawati R. Association between Muscle Mass and Muscle Strength with Physical Performance in Elderly in Surabaya. Surabaya Phys Med Rehabil J. 2020;2(1):24. DOI: 10.20473/spmrj.v2i1.16313.
  6. Jadczak AD, Makwana N, Luscombe-Marsh N, Visvanathan R, Schultz TJ. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews. JBI database Syst Rev Implement reports. 2018;16(3):752–75. DOI: 10.11124/JBISRIR-2017-003551.
  7. Rolland Y, Resnick B, Katz PR, Little MO, Ouslander JG, Bonner A, et al. Nursing home research: The first international association of gerontology and geriatrics (IAGG) research conference. J Am Med Dir Assoc. 2014;15(5):313–25. DOI: 10.1016/j.jamda.2014.03.004.
  8. Rizka A, Indrarespati A, Dwimartutie N, Muhadi M. Frailty among older adults living in nursing homes in Indonesia: Prevalence and associated factors. Ann Geriatr Med Res. 2021;25(2):93–7. doi: 10.4235/agmr.21.0033.
  9. Ishibashi H. Locomotive syndrome in Japan. Osteoporos Sarcopenia. 2018 Sep;4(3):86-94. doi: 10.1016/j.afos.2018.09.004.
  10. Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings: A systematic review. Journals Gerontol - Ser A Biol Sci Med Sci. 2013;68(1):39–46. DOI: 10.1093/gerona/gls174.
  11. Middleton A, Fritz SL, Lusardi M. Walking speed: The functional vital sign. J Aging Phys Act. 2015;23(2):314–22. DOI: 10.1123/japa.2013-0236.
  12. Shimada H, Suzuki T, Suzukawa M, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Uemura K, Ito T, Lee S, Park H. Performance-based assessments and demand for personal care in older Japanese people: a cross-sectional study. BMJ Open. 2013 Apr 10;3(4):e002424. doi: 10.1136/bmjopen-2012-002424.
  13. Muranaga S, Hirano K. Development of a convenient way to predict ability to walk, using a Two-Step Test. J Showa Med Assoc. 2003;63(3):301–8. DOI:10.14930/jsma1939.63.301
  14. Kojima K, Kamai D, Ishitani S, Watanabe S. Availability of the two-step test to evaluate balance in frail people in a day care service. J Phys Ther Sci. 2017;29(6):1025–8. doi: 10.1589/jpts.29.1025.
  15. Tarazona-Santabalbina FJ, Gómez-Cabrera MC, Pérez-Ros P, Martínez-Arnau FM, Cabo H, Tsaparas K, et al. A Multicomponent Exercise Intervention that Reverses Frailty and Improves Cognition, Emotion, and Social Networking in the Community-Dwelling Frail Elderly: A Randomized Clinical Trial. J Am Med Dir Assoc. Elsevier Inc.; 2016;17(5):426–33. doi: 10.1016/j.jamda.2016.01.019.
  16. Al Hayyan AJ, Mei Wulan SM, Masduchi RH, Nugraheni N, Poerwandari D, Melaniani S, et al. Validity and reliability of the loco-check questionnaire after cross-cultural adaptation for Indonesia. J Orthop Sci. 2023;28(1):267-271. doi:10.1016/j.jos.2021.10.008.
  17. Nayasista AH, Tinduh D, Alit Pawana IP, Mei Wulan SM, Utomo DN, Soenarnatalina M. Effect of combined locomotor training and aerobic exercise on increasing handgrip strength in elderly with locomotive syndrome: A randomised controlled trial. Ann Med Surg (Lond). 2022;78:103800. Published 2022 May 21. doi:10.1016/j.amsu.2022.103800.
  18. Maruya K, Asakawa Y, Ishibashi H, Fujita H, Arai T, Yamaguchi H. Effect of a simple and adherent home exercise program on the physical function of community dwelling adults sixty years of age and older with pre-sarcopenia or sarcopenia. J Phys Ther Sci. 2016;28(11):3183–8. doi: 10.1589/jpts.28.3183.
  19. Hashizume H, Yoshimura N, Nagata K, Miyazaki N, Ishimoto Y, Nishiyama R, et al. Development and evaluation of a video exercise program for locomotive syndrome in the elderly. Mod Rheumatol. 2013; Mar;24(2):250-7. doi: 10.3109/14397595.2013.854063.
  20. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743–9. doi: 10.1111/j.1532-5415.2006.00701.x.
  21. Van Abbema R, De Greef M, Crajé C, Krijnen W, Hobbelen H, Van Der Schans C. What type, or combination of exercise can improve preferred gait speed in older adults? A meta-analysis. BMC Geriatrics; 2015;15(1).
  22. Kota M, Moriishi M, Hazama A, Hiramoto K. Assessment of the effects of a group intervention program used in home-dwelling elderly individuals to promote home exercise and prevent locomotive syndrome. J Phys Ther Sci. 2019;31(6):470–4. DOI: 10.1589/jpts.31.470.

How to Cite

Prayogo, M., Rwahita Satyawati, Sari, D. I., Tinduh, D., Wulan, S. M. M., Mikami, Y., & Melaniani, S. (2023). Locomotion training addition to regular aerobic exercise improves walking speed and two-step test of the institutionalized older adult with Locomotive Syndrome stage 1: a randomized controlled trial. Bali Medical Journal, 12(1), 771–775.




Search Panel

Michael Prayogo
Google Scholar
BMJ Journal

Rwahita Satyawati
Google Scholar
BMJ Journal

Dyah Intania Sari
Google Scholar
BMJ Journal

Damayanti Tinduh
Google Scholar
BMJ Journal

Sri Mardjiati Mei Wulan
Google Scholar
BMJ Journal

Yukio Mikami
Google Scholar
BMJ Journal

Soenarnatalina Melaniani
Google Scholar
BMJ Journal