Are the 'hard' martial arts, such as the Korean martial art, TaeKwon-Do, of benefit to senior citizens?

Taekwondo Poomsae practise in slow motion and the balance of healthy older adults: A Pre-Experimental Study

BACKGROUND AND PURPOSE

Poor balance confidence and functional balance can lead to falls in community-dwelling older adults. Exercises utilising slow movements have been shown to improve balance in this population. It is hypothesised that by superimposing the use of slow movements onto Taekwondo Poomsae, there could be similar benefits in improving balance confidence and functional balance in older adults.

METHODS

This was a pre - experimental study. Fifteen community-dwelling older adults received 11 weeks of Slow Poomsae (SP) training using a proposed 50-min protocol. Pre- and post-intervention scores of the Activities-Specific Balance Confidence Simplified Scale (ABC-S), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and 'Timed Up and Go' test (TUG) assessments were recorded and compared.

RESULTS

Fifteen eligible participants with mean and standard deviation (SD) of age 73.8 (6.05) years completed the study. Significant improvements (p < 0.05) were seen in the pre-post differences between ABC-S, BBS, DGI, and TUG, with median score changes of 15 points (Z = -3.408), 3 points (Z = -3.306), 3 points (Z = -2.852), and 3.5 s (Z = -3.296) respectively.

CONCLUSION

The preliminary findings support the efficacy of SP as a potential balance training programme that is safe for healthy older adults to improve their balance confidence and functional balance. More research is required on this topic that leans towards a large population blinded randomised controlled trial with a longer intervention period and inclusion of a follow-up to further elucidate the effects of long-term practice and novelty of SP.

Effects of Functional Fitness Enhancement through Taekwondo Training on Physical Characteristics and Risk Factors of Dementia in Elderly Women with Depression

The purpose of this research is to identify the correlations between functional fitness enhancement through a long-term Taekwondo training program and the physical characteristics and risk factors of dementia among elderly women with depression. The study has found that conducting three 60-min Taekwondo training sessions a week for the duration of 12 weeks has enhanced a number of functional fitness indexes, including hand grip strength/weight (p < 0.01), 4-m gait speed (p < 0.001), 3-m timed up and go (p < 0.05), and figure-of-eight track (p < 0.05), and significantly improved general health condition indexes as well, including percent fat (p < 0.05), appendicular skeletal muscle mass index (p < 0.01), systolic blood pressure (p < 0.01), and diastolic blood pressure (p < 0.001). Furthermore, the arteriosclerosis index and cognitive function have been found to be improved with an increase of brain-derived neurotrophic factor (BDNF; which prevents dementia) and a significant decrease of β-amyloid—a risk factor of dementia—as a result of enhancements in serum lipids and adiponectin, confirming the positive effects of functional fitness enhancement on fighting depression, promoting physical characteristics, and reducing the risk factors of dementia.

Evaluating Martial Arts Punching Kinematics Using a Vision and Inertial Sensing System

Martial arts has many benefits not only in self-defence, but also in improving physical fitness and mental well-being. In our research we focused on analyzing the velocity, impulse, momentum and impact force of the Taekwondo sine-wave punch and reverse-step punch. We evaluated these techniques in comparison with the martial arts styles of Hapkido and Shaolin Wushu and investigated the kinematic properties. We developed a sensing system which is composed of an ICSensor Model 3140 accelerometer attached to a punching bag for measuring dynamic acceleration, Kinovea motion analysis software and 2 GoPro Hero 3 cameras, one focused on the practitioner's motion and the other focused on the punching bag's motion. Our results verified that the motion vectors associated with a Taekwondo practitioner performing a sine-wave punch, uses a unique gravitational potential energy to optimise the impact force of the punch. We demonstrated that the sine-wave punch on average produced an impact force of 6884 N which was higher than the reverse-step punch that produced an average impact force of 5055 N. Our comparison experiment showed that the Taekwondo sine-wave punch produced the highest impact force compared to a Hapkido right cross punch and a Shaolin Wushu right cross, however the Wushu right cross had the highest force to weight ratio at 82:1. The experiments were conducted with high ranking black belt practitioners in Taekwondo, Hapkido and Shaolin Wushu.

Screening of Sensitive Items on Gross Motor Development in Toddlers Aged 24~36 Months and Analysis of the Factors Influencing the Passing Rate

BACKGROUND

To save assessment time and improve the efficiency, it is necessary to find sensitive indicators from the test items of gross motor development in the C-LAP system for children aged 24~36 months and analyze the influencing factors of the passing rate of these indicators.

METHODS

This retrospective study was conducted among 1354 toddlers (3058 person-times) aged 24 to 36 months in Beijing, Shanghai, Guangdong between January 2013 and December 2019. A linear regression model and Cox regression model were performed to screen sensitive indicators and explore their influencing factors, respectively.

RESULTS

"Walk backwards", "Stand from supine position" and "Hop with one foot at least twice" are the three sensitive indicators for evaluating the development of gross motor function in 24~36 month old children. The child's physiological age at first measurement and region are the two common independent factors influencing the passing rate of the three items, while paternal age and education may influence one or two of them.

CONCLUSIONS

"Walk backwards", "Stand from supine position" and "Hop with one foot at least twice" are sensitive indicators for the effective evaluation of the development of gross motor function in 24~36 month old children, and their passing rates are influenced by some demographic variables.

Force transmission through the wrist during performance of push-ups on a hyperextended and a neutral wrist

STUDY DESIGN

Cross-sectional cohort.

INTRODUCTION

Push-ups are used ubiquitously to evaluate and strengthen the upper body. They are usually performed in 1 of 2 main ways: with the wrist in hyperextension and with the wrist in a neutral position.

PURPOSE OF THE STUDY

The purpose of our study was to compare the dynamic forces in the wrist during the 2 push-up styles.

METHODS

Fourteen volunteers performed push-ups in 2 different patterns: on a hyperextended wrist and a neutral wrist (NW). Two force plates and a motion capture system were used to measure the ground reaction forces (GRFs) and the kinematics of the upper extremity during push-ups. Kinematic and kinetic analyses were performed using Matlab software (Mathworks, Natick, MA).

RESULTS

The GRF vector was distributed differently during the different types of push-ups. For both methods, the total GRF carried by the upper dominant extremity was larger than those of the nondominant extremity. In the NW configuration, the GRF vector was more uniform throughout the push-up in the vertical direction. The horizontal distance between the capitate bone location and the GRF origin was smaller in hyperextension. The forces traveled more dorsally over a wider area and more ulnarly in the hyperextended wrist.

DISCUSSION

Forces are transmitted differently through the wrist in the 2 methods. Push-ups on an NW are likely safer because ligaments may be preferentially loaded in hyperextension. Further study may delineate the differences in the anatomic location of force transmission and the long-term clinical effect on the wrist.

CONCLUSIONS

This study supports the performance of push-ups on a wrist in neutral flexion extension; both to enable patients after surgery or injury to strengthen the upper body and prevent injury and long-term wear in the wrist. The knowledge gained from this study may assist in outlining guidelines for push-up performance.

LEVEL OF EVIDENCE

Diagnostic level 2a.

Taekwondo Enhances Cognitive Function as a Result of Increased Neurotrophic Growth Factors in Elderly Women

The purpose of this study was to investigate the effects of regular taekwondo (TKD) training on physical fitness, neurotrophic growth factors, cerebral blood flow (CBF) velocity, and cognitive function in elderly women. Thirty-seven women aged 65 or older were randomly assigned to either TKD (n = 19) or control (n = 18) group. TKD training was performed at 50⁻80% maximum heart rate (HRmax) for 60 min, five times per week for 16 weeks. All participants underwent the following examinations before and after the intervention: Senior Fitness Test; serum levels of neurotrophic growth factors, including brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1); systolic, diastolic, and mean blood flow velocity and pulsatility index of the middle cerebral artery using Doppler ultrasonography; Mini-Mental State Examination for dementia screening (MMSE-DS); and Stroop Color and Word Test (word, color, and color-word). In the TKD group, lower body strength and flexibility, aerobic endurance levels, BDNF, VEGF, and IGF-1 serum levels as well as the color-word test scores were significantly increased after as compared to before the intervention (p < 0.05). No statistically significant differences were found in cerebral blood flow velocities and the MMSE-DS score (p > 0.05). These findings suggest that regular TKD training may be effective in improving not only fitness but also cognitive function in elderly women. The latter effect may be due to increased neurotrophic growth factor levels.

Injury survey in Choi Kwang Do (CKD) martial art practitioners around the world: CKD is a safe form of training for adults

Among the many sports and activities to choose from, martial arts are becoming increasingly popular for health and fitness. Due to the different nature of the various styles of martial arts, injuries are not uncommon. Though there have been studies on the injury rates of several martial art styles, there have been none regarding Choi Kwang Do (CKD), a noncompetitive martial art with relaxed and fluid movements designed to promote health and fitness for people of all ages. The purpose of this study was to examine the rate of injury for adults training in CKD to find out whether this is a safe style of martial art for adults. This study found the prevalence, causes, severity, and types of injuries from CKD practitioners around the world through an online survey targeting adults (n=122), aged 18 or older, with varying years of training experience. The annual rate of injury was 11.73 for every 100 CKD practitioners. There was no correlation between the length of training experience and injury. Training frequency and duration had no significant relationship with injury rates. A significant positive relationship between training intensity and injury existed (P=0.009). The results of the study found that CKD can be an attractive option for adults of any age who are looking to learn a martial art or choose a physical activity with a low risk of injury, however the training intensity should be kept at a level that is not excessively high.

Health benefits of hard martial arts in adults: a systematic review

Participation in organized sports is promoted as a means of increasing physical activity levels and reducing chronic disease risk in adults. Hard martial arts practice (i.e. using body contact techniques), has gained in popularity over time. This review explores the evidence for health benefits of "hard" martial arts practice within the adult population. A systematic electronic database search was conducted, and quality assessments applied the Effective Public Health Practice Project tool. Twenty-eight studies met the inclusion criteria, examining balance, cognitive function, muscular skeletal status, psychological, cardiovascular fitness, and metabolic effects. The majority of studies reported positive effects resulting from hard martial arts practice, showing some improvement and maintenance of balance, cognitive function and psychological health. Benefits may be obtained regardless of the age of practice commencement. However, quality of the evidence is affected by methodological weaknesses across the studies. "Hard" martial arts seem to have potential to improve balance and cognitive functions that decline with age, which can lead to poorer health outcomes among the elderly (e.g. cognitive decline, falls and fractures). Benefits should be further investigated with improved intervention studies, representative samples and longer follow-up periods in order to establish associations with morbidity and mortality in the long term.

Tai Chi and Kung-Fu practice maintains physical performance but not vascular health in young versus old participants

OBJECTIVES

Kung-Fu and Tai Chi along with other martial arts are gaining popularity but studies examining the benefits of martial arts on physical fitness, vascular health, nutrition, and psychological wellness are limited. Aging is associated with declines in these health components. The objectives of this study were to examine whether Tai Chi and Kung-Fu training would maintain physical fitness, vascular health, and psychological wellness components on older versus younger practitioners.

METHODS

Seventeen subjects were recruited and divided into Young (age <40 years, n=9) and Old (age 40 years and above, n=8). Participants reported twice for health screens, vascular and nutrition assessment, and fitness tests. Mean differences were compared between groups for all tests using Student's t-tests.

RESULTS

Age, months of practice, systolic blood pressure, and cardiovascular augmentation index were significantly greater in Old versus Young (p=0.001, p=0.007, p=0.049, and p=0.011, respectively). Psychologically, old practitioners experienced greater sleep interference (p=0.035) and overall pain (p=0.036). No other differences existed for any variable.

CONCLUSION

Our study indicates that the practice of Tai Chi and Kung-Fu maintains physical fitness in older compared to younger practitioners. However, age associated changes in cardiovascular stiffness, systolic blood pressure, and pain were not prevented.

Effects of Taekwondo intervention on balance in children with autism spectrum disorder

The purpose of this study was to investigate the effects of an 8-week Taekwondo (TKD) intervention on balance in children with autism spec-trum disorder (ASD). A total of 14 children with ASD participated in this study. Eight children (eight males; mean age, 10.25±2.38 yr) completed TKD intervention (50 min/2 times/8 week), and six children received no intervention serving as controls (five males, one female; mean age, 10.00±2.83 yr). A computed posturography system with a long forceplate (NeuroCom Balance Master) was used to evaluate static (double and single leg stance with various test conditions) and functional balance (step-quick-turn). Balance was measured before and after the intervention. A mixed-model analysis of variance showed a significant group by time interaction in single leg stance balance. After the intervention, the TKD group displayed a greater improvement in single leg stance balance with eyes closed condition than the control group (P=0.046). Within-group analysis showed that the TKD group significantly improved single leg stance balance with eyes open condition (P=0.014). In addition, TKD group displayed trends of improvements in double leg stance balance with unstable surface under eyes closed condition (ES=0.83) and step-quick-turn (Cohen d [ES]=0.70). The control group did not show any significant changes in balance outcomes. In conclusion, TKD training can help children with ASD improve their balance. Children with ASD also showed a high rate of adherence (92%) to the TKD training. Our findings suggest that TKD can be a fun, feasible, and effective therapeutic option for balance improvement of children with ASD.

Pre-pubertal males practising Taekwondo exhibit favourable postural and neuromuscular performance

Background

The postural and neuromuscular performances in healthy children taekwondo (TKD) practitioners in comparison with control children were examined.

Methods

Seventeen healthy pre-pubertal males undertaking only physical education at school (age: 11.88 ± 0.33 years) and 12 pre-pubertal male TKD practitioners (>3 years, 4 sessions a week) (age 11.66 ± 0.49 years) were recruited. Performances in the dynamic postural control (Star Excursion Balance Test -SEBT), vertical jump [squat jump (SJ) and countermovement jump (CMJ)] and sprint running (distances: 5, 10, 20 and 30 m) tests were compared between the two groups.

Results

The performances of the TKD practitioners were better than those of the non-TKD active for the SEBT (for 14 of 16 conditions, p < 0.05), SJ (p < 0.01), CMJ (p < 0.03) sprint running (5 m, p < 0.01; 10 m, p < 0.04; the performances for the 20 and 30 m sprints were not significant, p > 0.05).

Conclusions

TKD practice would stimulate sensory input and motor output of the postural system that would enhance its efficiency. In addition, the dynamic nature of TKD would develop the muscle power of the lower limbs. In our sample of healthy pre-pubertal males, TKD appears to improve postural and neuromuscular functions, but further research is required.

Electronic supplementary material

The online version of this article (doi:10.1186/s13102-016-0040-2) contains supplementary material, which is available to authorized users.

Taekwondo training improves balance in volunteers over 40

Balance deteriorates with age, and may eventually lead to falling accidents which may threaten independent living. As Taekwondo contains various highly dynamic movement patterns, Taekwondo practice may sustain or improve balance. Therefore, in 24 middle-aged healthy volunteers (40–71 year) we investigated effects of age-adapted Taekwondo training of 1 h a week during 1 year on various balance parameters, such as: motor orientation ability (primary outcome measure), postural and static balance test, single leg stance, one leg hop test, and a questionnaire. Motor orientation ability significantly increased in favor of the antero-posterior direction with a difference of 0.62° toward anterior compared to pre-training measurement, when participants corrected the tilted platform rather toward the posterior direction; female gender being an independent outcome predictor. On postural balance measurements sway path improved in all 19 participants, with a median of 9.3 mm/s (range 0.71–45.86), and sway area in 15 participants with 4.2 mm²/s (range 17.39–1.22). Static balance improved with an average of 5.34 s for the right leg, and with almost 4 s for the left. Median single leg stance duration increased in 17 participants with 5 s (range 1–16), and in 13 participants with 8 s (range 1–18). The average one leg hop test distance increased (not statistically significant) with 9.5 cm. The questionnaire reported a better “ability to maintain balance” in 16. In conclusion, our data suggest that age-adapted Taekwondo training improves various aspects of balance control in healthy people over the age of 40.

Martial arts: time needed for training

Purpose

To measure the time needed to teach a series of martial arts techniques to proficiency.

Methods

Fifteen volunteer subjects without any prior martial arts or self-defense experience were recruited. A panel of martial arts experts selected 21 different techniques including defensive stances, arm blocks, elbow strikes, palm strikes, thumbs to eyes, instep kicks and a carotid neck restraint. The critical elements of each technique were identified by the panel and incorporated into a teaching protocol, and then into a scoring system. Two black belt martial arts instructors directed a total of forty-five 45-minute training sessions. Videotaped proficiency testing was performed weekly. The videotapes were reviewed by the investigators to determine the proficiency levels of each subject for each technique.

Results

The techniques were rated by the average number of training sessions needed for an individual to develop proficiency in that technique. The mean number of sessions necessary to train individuals to proficiency ranged from 27 to 38.3. Using this system, the most difficult techniques seemed to be elbow strikes to the rear, striking with thumbs to the eyes and arm blocking.

Conclusions

In this study 29 hours of training was necessary to train novice students to be proficient in 21 offensive and defensive martial arts techniques. To our knowledge, this is the first study that attempts to measure the learning curves involved when teaching martial arts techniques.

Does Taekwondo training improve physical fitness?

BACKGROUND

Taekwondo (TKD) is a popular sport practiced by people of all ages in more than 180 countries and it is generally considered as being beneficial to health even though the scientific evidence for this is not conclusive. Despite its popularity, there are very few studies on the health benefits of TKD, therefore this article attempts to pull together the existing strands of relevant research.

AIM

This paper aimed to review the effects of TKD training on physical fitness.

METHODS

A search of literature on both electronic and printed media was performed and 23 papers with relevance to the topic were included and critically reviewed. The main outcomes examined were anaerobic and aerobic fitness, body composition, muscle strength, endurance, power and flexibility.

RESULTS

There is no conclusive evidence in the literature that TKD practice can improve anaerobic fitness or muscle strength. However, TKD training may have some benefits in aerobic capacity, body composition (fat loss) and flexibility.

CONCLUSION

Physiotherapists or fitness instructors may consider recommending TKD to their clients as a beneficial form of exercise to promote aerobic fitness and flexibility.

Taekwondo training speeds up the development of balance and sensory functions in young adolescents

OBJECTIVES

This study aimed (1) to identify the developmental status of balance and sensory functions in young adolescents as compared to adults and, (2) to explore the effect of Taekwondo (TKD) training on the development of balance and sensory systems in young adolescents.

DESIGN

Cross-sectional controlled trial.

METHODS

Sixty-six participants including 42 adolescents (21 TKD practitioners, 21 non-TKD practitioners) and 24 adults were tested. The sway velocity of centre of gravity was recorded during standing on the non-dominant leg on a Smart Equitest ® system. The somatosensory, vestibular and visual ratios were also measured with the machine.

RESULTS

Adult participants swayed slower than both TKD and non-TKD adolescent groups during single leg stance with eyes open (p=0.007 and p<0.001, respectively). The TKD adolescent group, in turn, swayed slower than the non-TKD adolescent group (p<0.001). Adult participants had better visual ratio than both TKD and non-TKD adolescents (p=0.001 and p<0.001, respectively) while there was no difference between the TKD and non-TKD adolescents (p=0.164). For the vestibular ratio, there was no significant difference between adult participants and TKD adolescents (p=0.432). Adolescents who did not practice TKD showed significantly lower vestibular ratio than TKD adolescents and adults (p=0.003 and p<0.001, respectively). In addition, there was no significant difference in the somatosensory ratio among the 3 participant groups (p=0.711).

CONCLUSIONS

Participation in TKD appears to speed up the development of postural control and vestibular function in adolescents. Clinicians might advocate TKD exercise as a therapeutic intervention for young people with balance or vestibular dysfunctions.

Low-level Taekwondo practitioners have better somatosensory organisation in standing balance than sedentary people

Sports training, especially for those requiring fast and skilled movements have been reported to improve one's postural control, but the underlying sensory integration mechanism is unknown. The purpose is to explore the sensory organisation strategies for maintaining standing balance in Taekwondo practitioners, and to examine the quasi-static and dynamic balance performance in subjects with and without TKD training. Case-control study was used as a study design. Eleven subjects with low level of Taekwondo training for 1-3 years, and eleven sedentary healthy subjects were assessed with the sensory organisation tests (SOT) under six visual and somatosensory input conditions and their balance upon landing from self- or operator-triggered drop test with the eyes closed condition. The SOT measured the equilibrium scores, whereas the drop test assessed the time to stabilisation (TTS), normalised peak force and distance of antero-posterior and medial-lateral centre of pressure on landing. Results for the SOT test revealed that Taekwondo subjects performed better during stance with eyes closed on a fixed support than the untrained group (p = 0.011). For the drop tests, the untrained group was slower in postural correction as revealed by the longer TTS than the Taekwondo group after the operator-triggered drops (p = 0.018). All subjects had a larger normalised peak force in operator-triggered than self-triggered drops. In conclusion, we observed that people with low-level Taekwondo training have better balance performance than untrained subjects as shown in the SOT results and shorter TTS with the drop test. They may rely more on the somatosensory and vestibular inputs for maintaining balance. People with balance problems may benefit from Taekwondo training.

Effect of adapted karate training on quality of life and body balance in 50-year-old men

BACKGROUND

Aging is associated with a decrease in physical skills, sometimes accompanied by a change in quality of life (QOL). Long-term martial arts practice has been proposed as an avenue to counter these deleterious effects. The general purpose of this pilot study was to identify the effects of an adapted karate training program on QOL, depression, and motor skills in 50-year-old men.

METHODS AND DESIGN

Fifteen 50-year-old men were enrolled in a one-year prospective experiment. Participants practiced adapted karate training for 90 minutes three times a week. Testing sessions, involving completion of the MOS 36-item Short Form Health Survey (SF36) and Beck Depression Inventory, as well as motor and effort evaluation, were done at baseline, and six and 12 months.

RESULTS

Compared with baseline, participants had better Beck Depression Inventory scores after one year of karate training (P < 0.01) and better perception of their physical health (P < 0.01), but not on the mental dimension (P < 0.49). They also improved their reaction time scores for the nondominant hand and sway parameters in the eyes-closed position (P < 0.01).

CONCLUSION

Regular long-term karate practice had favorable effects on mood, perception of physical health confirmed by better postural control, and improved performance on objective physical testing. Adapted karate training would be an interesting option for maintaining physical activity in aging.

Tae Kwon Do: an effective exercise for improving balance and walking ability in older adults

BACKGROUND

Age-related declines in balance and walking ability are major risk factors for falls. Older adults reduce the dynamic components of walking in an effort to achieve a more stable walking pattern. Tae Kwon Do is an exercise that trains dynamic components of balance and walking that diminish with age.

METHODS

Twenty participants from a Tae Kwon Do exercise class (average age 72.7 years) and 20 nonexercising controls (average age 73.8 years) participated. Balance and walking ability for all participants were pretested and posttested using the following measures: single-leg stance (SLS), Multidirectional Reach Test (MDRT), Timed Up-and-Go (TUG), walking velocity, cadence, gait stability ratio (GSR), and sit-and-reach (S&R). Analysis of variance for a mixed design was used to assess differences at the 0.05 level of significance.

RESULTS

For nonexercising controls, no differences were found between pretest and posttest measures. Tae Kwon Do participants showed significant improvements on the MDRT when reaching backward, right, and left. TUG, walking velocity, GSR, and S&R also showed significant improvement in this exercising group.

CONCLUSIONS

Tae Kwon Do exercise was effective for improving balance and walking ability in community-dwelling older adults. These improvements were attributed to Tae Kwon Do movements that emphasize dynamic movement components typically deficient in the older adult walking pattern. Improving balance and walking ability through Tae Kwon Do exercise may serve to restore function that has declined with age and preserve mobility for older adults.

The Martial Arts

Given the increasing popularity of the martial arts, it is likely that physicians in all specialties encounter patients who participate. From pediatric patients, to geriatric patients, to those living with various disabilities, the martial arts may offer physical, psychologic, and therapeutic benefits. An appreciation of the physical demands of the martial arts is crucial to understanding the pathogenesis of injury as well as to planning treatment and prevention strategies and to determining safe return to participation after injury.

Falls in the elderly population

Falls among elderly persons remain a difficult problem with few easy solutions. Falls are symptomatic of underlying clinical deficits, and a multidisciplinary approach is essential in identifying the risk factors and appropriate treatments for these patients. Patients with chronic medical conditions, such as spinal cord injury, traumatic brain injury, and amputations, possess additional unique risk factors that must be addressed. Interventions include treatment of potentially reversible medical conditions such as B12 and vitamin D deficiencies and home modifications,balance and exercise training programs, medication modification, hip protectors, and monitoring devices. Physicians, patients, family members, and caretakers should be reminded that minimizing falls risk requires persistence, patience, and dedication. Progress may not be noted overnight, but adherence to recommendations correcting intrinsic and extrinsic factors can help to minimize falls and their potentially devastating complications.