Effects of Square-Stepping Exercise on balance and depressive symptoms in older adults

Multi-task exercise increases delta power in non-rapid eye movement sleep among older female adults: A randomized crossover trial

Delta power in electroencephalography during sleep has been used as a more quantitative approach to determine sleep depth and quality. Despite the positive effects of both exercise and cognitive activity on delta power during sleep, limited information is available regarding the effects of multi-task exercise, which combines these two activities. Therefore, this study aimed to investigate the impact of multi-task exercise on delta power during sleep. Fifteen older female adults participated in both multi-task and single-task exercises at low and moderate-to-vigorous intensities for 30 min each. Sleep architecture was recorded using polysomnography to compare the amount of delta power during sleep. Additionally, cortical hemodynamic changes in the prefrontal cortex were monitored using functional near-infrared spectroscopy before and after each exercise session. Low-intensity multi-task exercise increased cortical activation in the right and left ventrolateral prefrontal cortex and frontopolar area, which positively correlated with the increase in delta power. This study provides the first experimental evidence that low-intensity multi-task exercise enhances cortical activation in the prefrontal cortex of older female adults, leading to an increase in delta power during sleep. It also suggests that low-intensity multi-task exercise may be a more useful intervention for improving sleep quality in older adults.

Stepping towards health: a scoping review of square-stepping exercise protocols and outcomes in older adults

BACKGROUND

Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults.

METHODS

We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis.

RESULTS

A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson's disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function.

CONCLUSION

This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects.

Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study

BACKGROUND

Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT).

METHODS

Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system.

RESULTS

Both the SPPB total score improved significantly (p =  < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p =  < 0.001), walk ratio (p = 0.011), step length (p =  < 0.001), stride length (p =  < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible.

CONCLUSIONS

SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care.

TRIAL REGISTRATION

DRKS00026191.

Combined effect of daily physical activity and social relationships on sleep disorder among older adults: cross-sectional and longitudinal study based on data from the Kasama study

Background

This study investigated whether daily physical activity of older adults, combined with social relationships, is associated with the risk of sleep disorder. Further, it determined whether a high level of one variable with a low level of the other, leads to a significantly lower risk of sleep disorder than low levels of both.

Methods

The sample comprised 1339 community-dwelling older Japanese adults: 988 in Study 1 and 351 in Study 2. The level of daily physical activity and range of social relationships were assessed using the Physical Activity Scale for the Elderly and the Lubben Social Network Scale, respectively. The Pittsburgh Sleep Quality Index was used to assess sleep disorder. To test the combined relationships and effects in Studies 1 and 2, the medians for the respective scores of each of the following four groups that the participants were categorized into, were calculated: (1) low activity group with low social relationships, (2) low activity group with high social relationships, (3) high activity group with low social relationships, and (4) high activity group with high social relationships. After adjusting for potential confounders, a logistic regression analysis was conducted in Study 1. After adjusting for potential confounders, a Cox proportional hazards regression analysis was conducted in Study 2.

Results

Study 1 revealed that the high activity group with high social relationships showed a significantly lower risk of sleep disorder (ORs: 0.585, 95% CI: 0.404–0.847) than the low activity group with low social relationships. Study 2 also revealed that the high activity group with high social relationships showed a significantly lower prevalence of sleep disorder (HRs: 0.564, 95% CI: 0.327–0.974) than the low activity group with low social relationships.

Conclusions

Our findings suggest that for older adults with high social relationships, being physically active is favorably associated with sleep quality. However, a high level of one variable with a low level of the other has not been confirmed in improving sleep quality among older adults.

Acute effects of Square Stepping Exercise on cognitive and social functions in sedentary young adults: a home-based online trial

Background

The Square Stepping Exercise (SSE) is an exercise training program incorporating cognitive and physical exercise components, which was originally developed for older adults to reduce falling risks. SSE’s potential in delaying cognitive decline in older adults seems to be promising. However, there is scarce research on the SSE program with young adults. Furthermore, the outbreak of coronavirus disease has imposed people to change their lifestyle and behaviors, including exercise behaviors. Hence, the purpose of this study was to examine the acute effects of a home-based online SSE trial on cognitive and social functions in sedentary young adults.

Methods

A total of 18 young adults (6 males, 12 females) participated in the present study. They completed two exercise conditions (SSE and active control exercise), consisting of 3 sessions per week, over 2 weeks. A 2 times (pre vs. post) × 2 conditions (SSE vs. active control) repeated-measures ANCOVA was conducted on the score of the Modified Card Sorting Task with age and education year as covariates. A one-way repeated-measures MANOVA was performed on the subscale scores of the Physical Activity Group Environment Questionnaire to examine the effects of the exercise conditions (SSE vs. active control) on group cohesion.

Results

SSE was found effective to improve executive function such as abstract reasoning, mental flexibility, and problem-solving skills. Furthermore, participants’ perceptions of social interaction with their group, and closeness and bonding existing in their group were significantly higher in the SSE condition than the active control condition.

Conclusions

In the present study, SSE was conducted online and found to be effective to enhance executive function and group cohesion in sedentary young adults. These novel approach and findings are the strengths of the present study. People aged 60 years and over are more vulnerable to the coronavirus and at higher risk of developing serious illness. Given the coronavirus pandemic circumstances, it is worthwhile to explore the possibility of the online SSE approach to older adults in future research.

Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences

Falls and fall related injuries become an emerging health problem among older adults. As a result a review of the recent evidences is needed to design a prevention strategy. The aim of this review was to determine the effect of square stepping exercise (SSE) for fall down injury among older adults compared with walking training or other exercises. An electronic database search for relevant randomized control trials published in English from 2005 to 2016 was conducted. Articles with outcome measures of functional reach, perceived health status, fear of fall were included. Quality of the included articles was rated using Physiotherapy Evidence Database (PEDro) scale and the pooled effect of SSE was obtained by Review Manager (RevMan5) software. Significant effect of SSE was detected over walking or no treatment to improve balance as well to prevent fear of fall and improve perceived health status. The results of this systematic review proposed that SSE significantly better than walking or no treatment to prevent fall, prevent fear of fall and improve perceived health status.