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Feldenkrais Research Journal • volume 2 (2005)

Article

Learning to Improve Mobility and Quality of Life in a Well Elderly
Population: The Benefits of Awareness Through Movement

James Stephens
PhD, PT, CFP, Temple University, PA

Christopher Pendergast
BA, MPT, Widener University, PA

Beth Ann Roller
BA, MPT, Widener University, PA

Robert Scott Weiskittel
BS, MPT, Widener University, PA

Abstract
Objectives: This study tested the hypothesis that an alternative movement learning method, Awareness
Through Movement, would produce improvements in coordination, mobility, economy of movement and
quality of life in older adults.

Methods: A group of 31 older adults was studied using a prospective, repeated measures control group
design. The SF-36 was used to assess health status - quality of life. Video motion analysis was used to
collect data on walking and on a floor to stand transfer movement.

Results: Coordination of the transfer movement improved significantly in the experimental group. Vitality
and mental health scores also improved significantly in this group. Interesting differences between
young-old and old-old changes were observed.

Conclusions: Awareness Through Movement may be an additional effective method for pursuing the
objectives of Healthy People 2010.

Keywords
Feldenkrais, mobility, coordination, elderly, alternative learning method, Awareness Through Movement

Copyright ©: The copyright for this paper remains with the author(s).

Please cite: (First published in the) Feldenkrais Research Journal, volume 2; 2005.

Service marks: The terms Feldenkrais®, Feldenkrais Method®, Awareness Through Movement®, ATM®,
Functional Integration®, and FI® are service marked terms of the International Feldenkrais® Federation
(IFF) and Feldenkrais professional guilds and associations in many countries. In keeping with academic
conventions, they will not be service marked in the entire text as may be required in nonacademic use,

Published by the International Feldenkrais® Federation (IFF) https://feldenkrais-method.org
Available online at https://feldenkraisresearchjournal.org

https://feldenkrais-method.org/
https://feldenkraisresearchjournal.org


but only for the first and most prominent use of the terms. In recognition that these phrases are formal
terms referring to specific practices within the Method, and to the Method as a whole, capitalization of all
the words in each term has been retained.



    
IFF Academy 

Feldenkrais Research Journal 2 (2005) 
® 2005 by the author 

ISSN 1817-4000  
 

 
Learning to Improve Mobility and Quality of Life in a Well  
Elderly Population: The Benefits of Awareness Through Movement   
 
 
Principal Investigator and author for correspondence and reprint requests 
 
James Stephens  PT, PhD 
Physical Therapy Department 
Temple University     
3307 N. Broad Street 
Philadelphia, PA 19140 
Phone: 215-707-8085   
Fax:  215-707-7500     
Email:  james.stephens@temple.edu 
 
 
 
Co-investigators and authors: 
 
Christopher Pendergast  BA, MPT 
Widener University 
Chester, PA 19013 
 
Beth Ann Roller  BA, MPT 
Widener University 
Chester, PA 19013 
 
 
Robert Scott Weiskittel  BS, MPT 
Widener University 
Chester, PA 19013 
 
 
 



 2

Abstract 

Objectives:  This study tested the hypothesis that an alternative movement 

learning method, Awareness Through Movement, would produce improvements in 

coordination, mobility, economy of movement and quality of life in older adults. 

Methods:  A group of 31 older adults was studied using a prospective, repeated 

measures control group design.  The SF-36 was used to assess health status - quality of 

life.  Video motion analysis was used to collect data on walking  and on a floor to stand 

transfer movement.  

Results:   Coordination of the transfer movement improved significantly in the 

experimental group.  Vitality and mental health scores also improved significantly in this 

group.  Interesting differences between young-old and old-old changes were observed. 

Conclusions:  Awareness Through Movement may be an additional effective 

method for pursuing the objectives of Healthy People 2010.



 3

Introduction 

As people age there is increased risk of a variety of problems such as falling, 

injury, loss of mobility, social isolation and depression. The Healthy People 2010 report 

has placed a new emphasis on quality of life and overall well being as opposed to 

longevity.1,2  A variety of programs involving physical activity are being developed to 

address these risks and problems with the goal of improving quality of life.3  In 1949, 

Moshe Feldenkrais suggested that some of these problems may be the result of learning 

less than optimal habits and postural responses and could be corrected by a process of 

exploratory relearning of basic movement skills.4  He developed a method of teaching 

called Awareness Through Movement for this purpose.5  This teaching process can be 

used with large groups of people and even made available thru broadcast media.6  Several 

studies in recent years have documented that use of Awareness Through Movement can 

produce improvements in mobility7 and balance 8  in well elderly populations.  The 

objective of this study was to assess the hypothesis that an Awareness Through 

Movement training program would produce improvements in coordination, mobility, 

economy of movement and quality of life. 

Methods 

We studied the question of whether an Awareness Through Movement training 

program would improve the coordination and economy of movement and health 

status/quality of life in a well elderly population, using a prospective, pretest – posttest 

control group design.  Active, healthy adult volunteers between the ages of 60 and 90 

who were residents of a retirement community were recruited to participate in the study.  

A letter was placed in residents' mailboxes and a column was written in a community 



 4

newspaper inviting residents to an open community dialog during which there was a 

presentation and discussion of the project.  

Individuals were screened for inclusion criteria including age, ability to walk 

independently without an assistive device for 10 minutes, ability to walk on a treadmill at 

2-3 miles per hour, and ability to get up from the floor without assistance.  Individuals 

were excluded from participation if they presented with musculoskeletal or neurological 

problems preventing independent mobility, had uncontrolled hypertension, a history of 

falling related to cardiac problems, orthopedic surgery within the past year or previous 

training in the Feldenkrais method of Awareness Through Movement.  All participants 

meeting the selection criteria were ordered by age and gender and then alternately 

assigned to experimental (EXP) or control (CON) groups. These 2 groups were further 

stratified by dividing each equally into a younger and an older age group. All individuals 

received medical clearance to participate in the study from a physician.  Prior to 

screening, all individuals signed a consent form.  The study was approved by the Widener 

University Committee for the Protection of Human Subjects and by the Research Review 

Committee at the Kendall-Crosslands Retirement Community in Kennett Square, PA.   

The study was conducted over a period of 8 days.  On day 1, baseline data was 

collected from individuals in both groups.  On days 4 and 5, all members of the EXP 

group participated in a total of 10 hours of Awareness Through Movement lessons while 

the CON group went about their normal daily activities and meetings.  On day 8, post 

intervention data was collected from both groups. 



 5

The Awareness Through Movement Intervention 

The ATM classes were conducted in a large carpeted room with lighting and 

temperature to comfort so that all individuals in the group could participate 

simultaneously.  Individuals were seated in straight back chairs, standing, or lying on the 

floor on mats depending on the content of the lesson.  Lessons lasted about 45 minutes 

and were presented by 6 different instructors over the 2-day period.  A lesson consists of 

a period of movement exploration during which an instructor guides participants through 

a process of movement exploration by suggesting a variety of possible movement 

alternatives and directing attention to a range of possible sensory and perceptual 

experiences.  The lesson may be structured around a simple movement (e.g. rolling to the 

side) which is not identified as a goal of the lesson.  The movement serves as a structure 

for the participant to explore and appreciate a range of sensory experience and to work 

with a variety of strategies for organizing the suggested actions.  Ten lessons in all were 

presented: 1) leg movements sitting in a chair, 2) body image and pelvic movements 

sitting in a chair, 3) lengthening of the body in supine, 4) flexion movements in supine, 5) 

rotational movements in sidelying, 6) rotational movements transferring from a chair to 

standing, 7) sliding the leg to the side in supine, 8) rolling from supine to sit, 9) rolling 

from supine to prone, and 10) standing and walking.  There was no lesson in this 

sequence that dealt with the problem of coming to standing from supine, a dependent 

variable in the study. These lessons were based on a set of lessons titled “Innovations in 

Therapeutic Movement for Older Adults”.9 



 6

Outcome Variables and Data Collection Procedures 

Outcome data were collected in 4 areas: 1) responses on the SF-36 health status 

measure, 2) coordination in performance of a supine to stand movement, 3) energy 

consumption in treadmill walking, and 4) subjective feedback.   

1) The SF-36 (ver.2) was administered by interview to all participants in both pre and 

post intervention data collection sessions and scored using the criteria provided by the 

Medical Outcomes Trust.10,11   

2) Assessment of coordination of the supine to stand movement was done using video 

data.  Participants were asked to perform 4 repetitions of the movement from a supine 

position to standing at their normal pace.  The last 3 movements were recorded on 

video and the path of movement of the head was analyzed with the PEAK Motion 

Analysis system (Peak Performance, Englewood, CO).12,13   Time to complete the 

movement and the number of  acceleration units which the movement was composed 

of were selected as   variables describing coordination or skill in the movement.14 

3) Participants were videotaped during the last minute of a 4-minute treadmill walk at 

their preferred speed that was determined during screening.  A 10-second video clip 

was randomly selected from the last 30 seconds of video for data analysis.  Average 

vertical displacement of the sacrum during walking was determined using the PEAK-

5 Motion Analysis system.  The vertical displacement data were used to calculate a 

relative measure of energy expenditure.15 

4) Subjective feedback about awareness of changes in performance of selected daily 

activities was collected from the experimental group during the post intervention data 

collection using a written questionnaire. 



 7

Data Analysis 

 A clearer picture of the outcomes emerged by considering the possible impact of 

age as a separate variable.  The 2x2x2 design used three (intervention groups, age groups 

and time) factors with a repeated measure on the factor of time pre and post 

intervention.16 A general linear ANOVA model was used with 2 between subject 

variables for parametric data from treadmill and supine to stand performance.  To analyze 

the SF-36 data, which is non-parametric, the data was collapsed across the age variable 

and analyzed using Friedman's 2-way ANOVA.  All statistical analyses were conducted 

using SPSS v10.1.17  Internal consistency of the SF-36 scores was high as determined by 

Cronbach's alpha coefficients.18  PEAK 5 video data were analyzed for average sacral 

vertical deviation and movement units using software written in Labview by Michael 

Coleman. 

Results 

Forty-four residents expressed interest and agreed to participate in the screening 

process. Thirty-two subjects met the selection criteria. After group assignment, one 

subject was moved from experimental to control group due to scheduling problems. 

Another dropped out of the experimental group for personal reasons.   The final 

experimental group included 14 individuals: mean age 79 years, mean activity level19  of 

2.7 , mean resting heart rate 69 bpm, mean weight 67 kg, mean walking speed 165 

ft/minute.  The final control group included 17 individuals: mean age 77, mean activity 

level of 2.6, mean resting heart rate 72 bpm, mean weight 68 kg, mean walking speed 187 

ft/minute.  Differences between group means for all these characteristics were statistically 

insignificant except for walking speed.  Ninety-seven percent of participants were white.  



 8

Participants were between the ages of 68 and 89.  There were 12 men and 19 women. All 

were well educated, in good health and living independently, a robust group.20 

Table 1 A and B show the outcomes for SF-36 assessment.  Two of the 8 SF-36 

subscales showed significant change across the 8-day period of the study.  There was a 3-

4% background of improvement in these subscales in the control group.  However in the 

experimental group the range of change was greater than 8% for the mental health 

variable and 12% for the vitality variable. 

Table 1C shows the outcome for the assessment of economy of walking on a 

treadmill.  This variable assesses the up and down movement of the center of mass which 

is highly correlated with energy consumption (r = 0.9).15  A decrease  in the up and down 

movement, a smaller average deviation, reflects less work and therefore greater economy 

of movement.  We observed a decrease in sacral deviation of about the same magnitude 

across time in both experimental and control groups.  This suggests that there is a 

learning effect occurring with people who do not spend a lot of time walking on the 

treadmill.  This was in spite of allowing people to practice a prescribed amount after 

screening and before the first data collection.  A learning effect may account for some of 

the change seen in the control group in the supine to stand task as well.  

Table 1 D and E show the outcomes for assessment of the supine to stand task.  

Decreasing time of performance is considered an aspect of skill acquisition.21  A higher 

level of skill in this task has been documented in a normal adult as compared to an age 

matched population with multiple sclerosis.12  A decrease in the number of movement 

units that make up a complex movement is also considered to indicate an increase in 

coordination in performance of that task 14  as we have observed previously with a 



 9

population with multiple sclerosis.12  Here we observed significant changes as an 

interaction of group x age x time in both variables.  In both measures there is a decrease  

in the younger group and an increase in the older group. 

The specific categories of subjective feedback  (Table 2) were asked about 

because they are areas in which people might experience change in behavior as a result of 

participating in Awareness Through Movement lessons.13   It is interesting to note that 

there was no report of performance becoming worse or more difficult.  Of greatest 

interest is the fact that 93% of people who participated in Awareness Through Movement 

reported that the supine to stand transfer was easier.  This was in spite of the fact that the 

change observed was equally divided between those who decreased time and movement 

units and those who increased time and movement units.  The last two categories, 

breathing and sleeping, lend reliability to the subjective data because both of these were 

areas in which we expected significant changes based on previous clinical experience and 

no changes were reported. 

Discussion 

It has been shown that perceived control is positively related to health status in the 

old/old.22  A primary finding of this study is improvement of the SF-36 vitality and 

mental health subscale scores in the experimental group.  We take this to reflect an 

increased sense of well being resulting from participation in Awareness Through 

Movement.  This has been observed previously in work with people with multiple 

sclerosis 13  and with a well elderly group.23  In a previous study with people with 

multiple sclerosis,24 we observed significant improvements in balance performance and 

balance confidence.  In a related, unpublished qualitative study, (Personal 



 10

communication, Dominique duShuttle, May 2000, Research meeting) themes from a 

focus group suggested that improved sense of well being is related to two issues: 1) 

improved physical function and confidence, and 2) an expanded sense of the choices 

available in problem solving engendered by the Awareness Through Movement process.   

The supine to stand performance outcomes of the under 78 or "young/old" 

experimental group support our hypothesis that use of Awareness Through Movement 

can improve coordination.  This was also supported by the subjective feedback that the 

floor transfer was easier for almost everyone in the experimental group. However the 

bifurcation of response seen with the "old/old" (78 and over) group is puzzling.  Possibly 

people realized an option to move more slowly and carefully in an activity that would be 

complex, unfamiliar and difficult for most 80 year olds.  Possibly the learning process 

was different in the "old/old" group.  It has been suggested that there are differences in 

implicit learning between young and old that could account for differences in 

performance.25,26,27  The changes observed may be transient due to the newness of the 

learning.28  Possibly there were changes in sensory function, biomechanics or the postural 

control process requiring a different solution to a similar problem.13,29,30,31   

The beneficial effects of exercise on various physiological and psychological 

parameters related to maintaining mobility and independence have been well 

established.3,32,33,34  This study suggests that an approach such as Awareness Through 

Movement, which improves coordination, vitality, balance and well being may be a 

useful adjunct to enable older people to optimize the benefits of exercise and therefore 

might be widely used as a preventative as well as a restorative intervention in pursuit of 

the objectives of Healthy People 2010. 



 11

The population that was studied was not only socioeconomically advantaged but 

also generally robust. The available rehabilitation literature suggests it's effectiveness 

with other groups;9,24  however, it remains to be determined if the Awareness Through 

Movement approach could contribute as much for other populations which might be less 

advantaged in a variety of ways.  

References 

1. Drewnowski A, Evans WJ. Nutrition, physical activity, and quality of life in older 

adults: summary. JGerontol A Biol Sci Med Sci. 2001; 56 Spec. No2 (2):89-94. 

2. DiPietro L. Physical activity in aging: changes in patterns and their their relationship 

to health and function. JGerontol A Biol Sci Med Sci. 2001; 56 Spec. No2 (2):13-22. 

3. Province MA, Hadley EC, Hornbrook MC et al. The effects of exercise on falls in 

elderly patients: A preplanned meta-analysis of the FICSIT trials. JAMA. 1995; 

273(17): 1341-1347. 

4. Feldenkrais M. Body and Mature Behavior: A Study of Anxiety, Sex, Gravitation, and 

Learning.  New York, NY: International Universities Press; 1949: 66-78. 

5. Feldenkrais M. Awareness Through Movement. New York, NY: Harper and Row; 

1972: 3-65. 

6. Kegeles J. Providing Awareness Through Movement Lessons on a Local Access 

Cable Channel  in Worcester, MA. Platform Presentation at the Research Forum, 

Annual Conference, Feldenkrais Guild of North America; Tamiment, PA; August 

1997. 



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7. Bennett JL, Brown BJ, Finney SA, and Sarantakis CP.  Effects of a Feldenkrais Based 

Mobility Program on Function of a Healthy Elderly Sample.  Issues on Aging, a 

publication of Geriatric Section of APTA. February 1998; 21(1): 31 

8. Hall SE, Criddle A, Ring A, et al.  Study of the effects of various forms of exercise on 

balance in older women.  Unpublished Manuscript Healthway Starter Grant, File 

#7672, Dept of Rehabilitation, Sir Charles Gairdner Hospital, Nedlands, Western 

Australia,  1999. 

9. Wildman F, Stephens J, Aum L. Feldenkrais Method. In Novey DW ed. Clinician’s 

Complete Reference to Complementary and Alternative Medicine. St. Louis, MO: 

Mosby Publishers; 2000: 393-406. 

10. Brazier JE, Harper R, Jones NM et al. Validating the SF-36 Health Survey 

questionnaire: New outcome measure for primary care. Brit Med J. 1992; 305: 160-

64. 

11. Hayes V, Morris J, Wolfe C et al. The SF-36 Health Survey questionnaire: Is it 

suitable for use with older adults? Age and Aging. 1995; 24: 120-125. 

12. Stephens JL, Crandall G. Measurement of coordination of  a complex movement in 

normals and subjects with multiple sclerosis using the PEAK-5 2D system. Phys 

Ther.1995; 75 Suppl.(5):R91 

13. Stephens JL, Call S, Evans K et al.  Responses to ten feldenkrais awareness through 

movement lessons by four women with multiple sclerosis: Improved quality of life.  

Physical Therapy Case Reports. 1999; 2(2): 58-69. 



 13

14. Kluzik J, Fetters L, Coryell J. Quantification of control: A preliminary study of the 

effects of neurodevelopmental treatment on reaching in children with spastic cerebral 

palsy. Phys Ther. 1990; 70: 65-78. 

15. Kerrigan DC, Viramontes BE, Corcoran PJ et al.  Measured versus predicted vertical 

displacement of the sacrum during gait as a tool to measure biomechanical gait 

performance. Am J Phys Rehabil.  1995; 74: 3-8. 

16. Portney LG, Watkins MP. Foundations of  Clinical Research: Applications to 

Practice.  Norwalk, CT: Appleton and Lange; 1993: 373-395. 

17. SPSS Base 10.0 Users Guide. New York, NY: Prentice Hall; 1999. 

18. Cronbach LJ, Gleser GC, Nanda H et al. The dependability of Behavioral 

Measurements: Theory of Generalizability for Scores and Profiles. New York, NY: 

Wiley; 1972: 251ff. 

19. Lieper CI, Craik RL. Relationships between physical activity and the temporal 

distance characteristics of walking in elderly women. Phys Ther. 1991; 71:791-802. 

20. Garfein AJ, Herzog AR.  Robust aging among the young-old, the old-old, and the 

oldest-old. JGerontol B Psychol Sci Soc Sci. 1995; 50(2): S77-87. 

21. Schmidt RA, Lee TD. Motor Control and Learning: A Behavioral Emphasis 3rd ed. 

Champaign, IL: Human Kinetics; 1999: 15-40. 

22. Menec VH, Chipperfield JG. The interactive effect of perceived control and 

functional status on health and mortality among young-old and old-old adults. 

JGerontol B Psychol  Sci Soc Sci. 1997; 52(3):P118-126. 

23. Gutman G, Herbert C, Brown S.  Feldenkrais vs conventional exercise for the elderly. 

J Gerontology . 1977; 32(5): 562-572. 



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24. Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of Awareness 

Through Movement improves balance and balance confidence in people with multiple 

sclerosis: a randomized controlled study.  Neurology Report . 2001; 25(2):39-49. 

25. Harrington DL, Haaland KY. Skill learning in the elderly: diminished implicit and 

explicit memory for a motor sequence. Psychol Aging. 1992; 7(3): 425-434. 

26. Howard JH, Howard DV. Age differences in implicit learning of higher order 

dependencies in serial patterns. Psychol Aging. 1997; 12(4): 634-656. 

27. Wishart LR, Lee TD. Effects of aging and reduced relative frequency of knowledge 

of results on learning a motor skill.  Percept Mot Skills. 1997; 83(3 Pt 1): 1107-1122. 

28. Bellgrove MA, Phillips JG, Bradshaw JL, Gallucci RM.  Response (re-)programming 

in aging: a kinematic analysis. JGerontol A Biol Sci Med Sci. 1998; 53(3): M222-227. 

29. Woollocott MH, Shumway-Cook A, Nashner LM. Aging and postural control: 

changes in sensory organization and muscular coordination.  Int J Aging Hum Dev.  

1986; 23(2): 97-114. 

30. Lord SR, Ward JA.  Age-associated differences in sensori-motor function and balance 

in community dwelling women.  Age Aging.  1994; 23(6): 452-460. 

31. Slobounov SM, Moss SA, Slobounov ES, Newell KM.  Aging and time ti instability 

in posture. JGerontol A Biol Sci Med Sci. 1998; 53(1): B71-78. 

32. Daley MJ, Spinks WL.  Exercise, mobility, and aging. Sports Med.  2000; 29(1): 1-

12. 

33. Gardner MM, Robertson MC, Campbell AC.  Exercise in preventing falls and fall 

related injuries in older people: a review of randomized, controlled trials. Br J Sports 

Med. 2000; 34(1): 7-17. 



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34. Hertel KL, Trahiotis MG.  Exercise in prevention and treatment of osteoporosis: the 

role of physical therapy and nursing.  Nurs Clin North Am.  2001; 36(3): 441-453, 

viii-ix. 

 

 
 
 
 
 
 



 16

 
 
Table 1 -  Changes in Dependent Variables by Group, Age and Time 

A - SF36  Vitality 
Variables  

Group Age Time Mean S.E. % Change n 
Con  Pre 64.1 4.3 17 

  Post 66.9 5.5 
+4.3 

17 
Exp  Pre 64.0 2.9 14 

  Post 71.7  3.7 
+12.0 

14 
Significant change in Group*Time:  p=.04 
Significant change in Group*Time:  p=.02 
 
B - SF36  Mental Health 

Variables  
Group Age Time Mean S.E. % Change n 
Con  Pre 82.8 2.9 17 

  Post 85.5 2.9 
+3.2 

17 
Exp  Pre 83.3 2.3 14 

  Post 90.2 1.7 
+8.3 

14 
Significant change in Group*Time:  p=.01 
 
C - Sacral Deviation  (inches) 

Variables  
Group Age Time Mean S.E. % Change n 
Con  Pre 1.35 .10 17 

  Post 1.25 .08 
-7.6 

17 
Exp  Pre 1.05 .11 14 

  Post .985 .09 
-5.8 

14 
 
D - Supine to Stand Time (sec) 

Variables  
Group Age Time Mean S.E. % Change n 
Con 78 and up Pre 9.34 1.60 8 

  Post 8.85 1.39 
-5.2 

8 
 Under 78 Pre 5.08 1.51 9 
  Post 4.82 1.31 

-5.1 
9 

Exp 78 and up Pre 8.29 1.60 8 
  Post 9.60 1.39 

+15.7 
8 

 Under 78 Pre 8.61 1.85 6 
  Post 7.75 1.60 

-10.1 
6 

Significant change in Group*Age*Time:  p=.05 
 
 
 
 
 
 



 17

E - Supine to Stand Time (movement units) 
Variables  

Group Age Time Mean S.E. % Change n 
Con 78 and up Pre 11.87 2.38 8 

  Post 10.12 1.81 
-14.7 

8 
 Under 78 Pre 5.55 2.24 9 
  Post 5.77 1.71 

+4.0 
9 

Exp 78 and up Pre 10.25 2.38 8 
  Post 12.37 1.81 

+20.6 
8 

 Under 78 Pre 10.66 2.75 6 
  Post 9.33 2.09 

-12.5 
6 

Significant change in Group*Age*Time:  p=.06 
 
 
 
 
 
 
 

Table 2 - Subjective Feedback from Experimental Group 

Category  with -                                          %      yes responses 
1.  Feel taller                       
29% 

Same height              
71% 

Feel shorter                0% 

2.  Walking easier               
43% 

Walking same            
57% 

Walking harder           0% 

3.  Floor transfer easier     93% Transfer same            7% Transfer harder         0% 
4.  Breathing fuller                
7% 

Breathing same         
93% 

Breathing shallower   0% 

5.  Sleeping better                
0% 

Sleeping same        
100% 

Sleeping worse          0% 

 
 
 

 


