Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Assessing standing balance with MOTI: a validation study

OBJECTIVES

This study aimed to determine the validity and reliability of a new device called MOTI for measuring balance by comparing its performance that with of the gold-standard force platform.

METHODS

The study involved collecting data from both devices in dual- and single-leg standing positions with eyes open and closed and using statistical measures to compare their performance.

RESULTS

The results showed that MOTI can accurately measure balance during dual-leg standing tasks but has poor to moderate performance during single-leg standing tasks. However, it could detect small changes in postural sway caused by a reduced base of support and/or visual feedback. The study also found that the test-retest reliability was poor to moderate for both devices.

CONCLUSIONS

These findings suggest that MOTI has potential as a reliable tool for measuring balance during certain tasks, but further research is needed to improve its performance during single-leg standing. This study provides valuable insights into the validity and reliability of MOTI for measuring balance and highlights the need for further investigation.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults

BACKGROUND

Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood.

AIM

The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals.

METHODS

Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance.

RESULTS

No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006).

DISCUSSION

LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance.

CONCLUSION

A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use

Background

People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use.

Method

PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined.

Discussion

A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial.

ClinicalTrialsgov Identifier

NCT04804579. Boston University Protocol Record H-41041.

Relationship Between Sleep Quality and Falls Among Elderly People in Amirkola, Northern of Iran

Background: Aging is considered a biological, natural, and inevitable phenomenon that is associated with common problems of sleep quality and falls. The aim of this study was to evaluate the relationship between sleep quality and falls among the elders of Amirkola. Methods: In this case-control study, 250 elders, who were exposed to the falling, and 500 people without the previous falling were randomly selected during 2016-2017. The data were collected according to demographic and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Results: There was a significant relationship between sleep quality and falling, while no significant relationship was found between demographic characteristics (e.g., gender, marital situation, age, educational level, occupation, and satisfaction of income) and falling. The mean of chronic diseases was 3.65±2.29 and 4.38±2.75 in control and case groups, respectively (P=0.0001). A significant difference was found between the two groups regarding the number of falls during the last 12 months (P=0.0001). There was a significant positive correlation between the score of poor sleep quality and the number of chronic diseases (P=0.001, r=0.352), the number of falls during the last 12 months (P=0.001, r=0.137), and the number of falling during the last 12 months with the number of chronic diseases (P=0.001, r=0.208). There was a significant negative correlation between poor quality sleep with the score of physical activity (P=0.001, r=-0.166) and the number of chronic diseases with the physical activity score (P=0.001, r=-0.259). After adjusting the other variables, the number of chronic diseases (P=0.002, OR=1.114) and history of smoking (P=0.018, OR=1.678) were the most effective factors of falling. Finally, a direct positive correlation was observed between the total scores of sleep quality and falling in terms of gender in the older woman of Amirkola (P=0.001, OR=2.080). Conclusion: Awareness of the factors of falls can help develop prevention strategies and appropriate health services.

Effects of sling exercise therapy on post-stroke walking impairment: a systematic review and meta-analysis

Walking impairment is a common consequence of stroke, resulting in long-term disability. Trunk muscle strength has been proven to be associated with post-stroke walking performance. As a type of trunk training, sling exercise therapy (SET) has been widely used to improve the trunk function in stroke patients. The purpose of this systematic review was to investigate the efficacy of SET on post-stroke walking impairment. Seven databases were systematically searched for eligible studies from their inception to 1 August 2021. Review Manager 5.3 software was used for this meta-analysis. The overall quality of included studies was evaluated by the physiotherapy evidence database scale. Twenty-five randomized controlled trials involving 1504 patients were included (23 in China and two in South Korea). In summary, SET more effectively improved the walking ability of post-stroke patients than conventional physical therapy or trunk training. The pooled analysis demonstrated that SET had positive effects on the 10 m maximum walking speed, integrated electromyography value of rectus femoris, biceps femoris and gastrocnemius, functional ambulation category, timed up and go test, and step length. At least in East Asia, our findings support SET to manage the post-stroke walking impairment.

Determining the Profile of People with Fall Risk in Community-Living Older People in Algarve Region: A Cross-Sectional, Population-Based Study

One in three people aged 65 years or older falls every year. Injuries associated with this event among the older population are a major cause of pain, disability, loss of functional autonomy and institutionalization. This study aimed to assess mobility and fall risk (FR) in community-living older people and to determine reliable and independent measures (health, social, environmental and risk factors) that can predict the mobility loss and FR. In total, 192 participants were included, with a mean age of 77.93 ± 8.38. FR was assessed by EASY-Care (EC) Standard 2010, the Tinetti Test and the Modified Falls Efficacy Scale (MFES). An exploratory analysis was conducted using the divisive non-hierarchical cluster method, aiming to identify a differentiator and homogeneous group of subjects (optimal group of variables) and to verify if that group shows differences in fall risk. Individually, the health, social, environmental and risk factor categories were not found to be an optimal group; they do not predict FR. The most significant predictor variables were a mix of the different categories, namely, the presence of pain, osteoarthritis (OA), and female gender. The finding of a profile that allows health professionals to be able to quickly identify people at FR will enable a reduction in injuries and fractures resulting from falls and, consequently, the associated costs.

Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial

OBJECTIVE

To investigate improvement in balance abilities compared between walking meditation and balance training among older adults with history of fall.

INTERVENTIONS

Walking meditation or mindfulness meditation whilst standing and moving (n = 35) or balance training (n = 33) 20-30 min/day, 5-7 days/week for 24 weeks was performed at home.

MAIN OUTCOMES

The primary outcomes were dynamic balance abilities as assessed by Timed Up and Go test (TUGT), and static balance as assessed by Functional Reach Test (FRT) and Single Leg Stance Test (SLST). The secondary outcomes were quality of life as measured by the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), and mental health as evaluated by the Thai Geriatric Mental Health Assessment Tool-15 (TGMHA-15). All outcomes were assessed at baseline, 6 months, and 9 months. Self-reported compliance, adverse events, and patient satisfaction were recorded at 6 and 9 months.

RESULTS

The mean age was 69 years (range: 60-85). No significant difference was observed between groups for the 3 primary outcome measures. The mean difference (95% confidence interval) between groups was -0.48 (-1.40, 0.44) for TUGT, -1.11 (-3.66, 1.45) for FRT, and 0.82 (-5.03, 6.67) for SLST. The EQ-5D-5L and TGMHA-15 also showed no significant difference between groups. Most participants were in good compliance with the exercise protocol (48.3-68.0%), and no serious adverse events were reported.

CONCLUSION

Our results showed walking meditation to be comparable to balance training for improving balance abilities in older adults with history of fall. Walking meditation may be considered an alternative treatment for improving balance abilities in this patient population.

The effect of balance exercises and computerized cognitive training on psychomotor performance in elderly

[Purpose] The purpose of this study was to investigate the effect of balance and computerized cognitive training on psychomotor performance in elderly females. [Subjects and Methods] Twentynine elderly females with the mean age of 63–71 years old were applied voluntarily and randomly allocated to four groups: balance training (3 d/wk for 12 wk), balance training with computerized cognitive training (3 d/wk for 12 wk), computerized cognitive training group and control group. Psychomotor performance of all subjects was measured by Vienna Test System which was a computerized psychological assessment tool. Determination test (DT) and Visual Pursuit Test (VPT) were used as indexes of psychomotor performance. [Results] The results suggested that DT and VPT were significantly improved in all experimental groups with greater improvement in the balance supplemented with computerized cognitive training group. [Conclusion] Balance training and computerized cognitive are highly recommended in elderly with the aim of increasing cognitive performance.

Views and Expectations of Community-Dwelling Thai Elderly in Reporting Falls to Their Primary Care Physicians

Fall among older adults is a concern in Thailand. The challenge for primary care physicians is to deliver effective interventions potentially adhered to by older people. This research employed a mixed-methods design to understand factors leading to fall reporting by community-dwelling Thai elders and their expectations regarding fall prevention education. Participants ( N = 305) who had fallen in the last year completed a questionnaire in the quantitative phase, and 50 of these were interviewed in-depth in the qualitative phase. Results revealed that only 39% reported their fall. Participants with comorbidities were 1.6 times more likely to report falling than those without (odds ratio = 1.61, confidence interval = [1.01, 2.58]). Post-fall pain (84%) was the strongest reason for reporting. Some participants believed that falling is an inevitable life event. It is crucial to encourage older adults to report falling, to provide targeted education, and to focus on improving the overall health status of older adults.

Balance Exercises Circuit improves muscle strength, balance, and functional performance in older women

This study introduces the Balance Exercises Circuit (BEC) and examines its effects on muscle strength and power, balance, and functional performance in older women. Thirty-five women aged 60+ (mean age = 69.31, SD = 7.35) were assigned to either a balance exercises group (BG, n = 14) that underwent 50-min sessions twice weekly, of a 12-week BEC program, or a wait-list control group (CG, n = 21). Outcome measures were knee extensor peak torque (PT), rate of force development (RFD), balance, Timed Up & Go (TUG), 30-s chair stand, and 6-min walk tests, assessed at baseline and 12 weeks. Twenty-three participants completed follow-up assessments. Mixed analysis of variance models examined differences in outcomes. The BG displayed improvements in all measures at follow-up and significantly improved compared with CG on, isokinetic PT60, PT180 (p = 0.02), RFD (p < 0.05), balance with eyes closed (p values range .02 to <.01) and TUG (p = 0.03), all with medium effect sizes. No changes in outcome measures were observed in the CG. BEC improved strength, power, balance, and functionality in older women. The BEC warrants further investigation as a fall prevention intervention.

Effects of a balance training program using a foam rubber pad in community-based older adults: a randomized controlled trial

BACKGROUND AND PURPOSE

Exercise programs aimed at improving balance are effective in fall prevention for older adults. Guidelines indicate that unstable elements should be integrated in balance training with this population. Balance training on an unstable surface facilitates proprioception mediated by skin receptors in the soles of the feet and by mechanoreceptors in the joints and muscles. This randomized controlled trial examined whether balance training performed using a foam rubber pad was more beneficial than balance training performed on a stable flat surface in older adults.

METHODS

Older adults using Japanese community day centers once or twice per week were enrolled in this trial. In total, 93 participants were randomized to 1 of 3 groups: foam rubber exercise group (n = 32), stable surface exercise group (n = 31), and control group (n = 30). Participants in the foam rubber and stable surface exercise groups attended a 60-minute exercise class once a week for 4 months and followed a home-based exercise routine. Outcome measures were the following performance tests: the one-leg standing test (OLST), the chair standing test, the timed up-and-go test (TUGT), and the tandem-stance test (TST). These assessments were conducted before the intervention, and at 1, 2, 3, and 4 months after starting the intervention.

RESULTS

There were group × time interactions (P < 0.001) for all performance tests. The foam rubber exercise group showed significant improvements in the OLST, TST, and TUGT at 1 to 4 months compared with the control group (P < 0.02). The foam rubber exercise group also showed significant improvements in the OLST and TST at 2 and 3 months compared with the stable surface exercise group (P < 0.02). Within the foam rubber exercise group, the OLST, TUGT, and TST, at 1 to 4 months, were significantly improved compared with before the intervention (P < 0.01). Within the stable surface exercise group, the TUGT and TST, at 3 and 4 months, were significantly improved compared with before the intervention (P < 0.01).

CONCLUSIONS

This study confirms that balance training in older adults performed using a foam rubber pad is effective for improving balance ability, and that this improvement occurs 2 months earlier compared with balance training performed on a stable surface. These findings suggest that balance training performed using a foam rubber pad is beneficial to clients and service providers because the programs improve physical functioning with a reduced number of exercise sessions.

Exercise for reducing fear of falling in older people living in the community

BACKGROUND

Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls.

OBJECTIVES

To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts.

SELECTION CRITERIA

We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses.

MAIN RESULTS

We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling.

AUTHORS' CONCLUSIONS

Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.

Influences on modern multifactorial falls prevention interventions and fear of falling in non-frail older adults: a literature review

This review explores underlying features that may influence fear of falling and the effectiveness of multifactorial falls prevention programs in community dwelling non-frail adults aged 65 and older. It also examines the interrelationship between fear of falling and multifactorial falls prevention interventions. A literature search of medical databases was conducted to identify articles that address the fear of falling and multifactorial programs as either a primary or secondary component of their findings. Multifactorial interventions were assessed in terms of their program content, design, demographics, implementation techniques, and cost-effectiveness. Falls are a common, but preventable, cause of morbidity and injury in older adults 65 and over. In addition to physiological variables, fear of falling and self-efficacy are psychosocial factors that impact the incidence of falls in this population. Addressing fear of falling in addition to physiological parameters may influence the success of multifactorial falls prevention programs for adults 65 and over.

Secondary prevention of osteoporotic fractures--an "OPTIMAL" model of care from Singapore

A significant care gap exists in the management of osteoporotic fractures. Osteoporosis Patient Targeted and Integrated Management for Active Living (OPTIMAL) is a secondary fracture prevention program instituted in the public hospitals of Singapore. We aim to describe the operational characteristics of OPTIMAL and initial audit data of patients who were recruited into the program at Singapore General Hospital.

INTRODUCTION

Fractures often represent the first opportunity for care of osteoporosis. However, a significant care gap still exists in the management of these sentinel events and underdiagnosis and undertreatment of osteoporotic fractures are prevalent worldwide. Fracture liaison services run by care coordinators have been shown to reduce the fracture care gap. OPTIMAL is a clinician champion-driven, case manager-run secondary fracture prevention program set up in the public hospitals of Singapore in 2008.

METHODS

We present the operational characteristics and initial audit data of OPTIMAL from the largest tertiary teaching hospital in Singapore.

RESULTS

One thousand and fourteen patients have been recruited into OPTIMAL at our hospital since 2008, and 476 patients are currently in active follow-up. Two hundred and eighty-seven patients had completed a 2-year follow-up at the hospital as of August 2012 and were evaluated; 97.5% of these patients had DXA evaluation upon enrollment into the program, and 62% of the patients reported compliance with an exercise program over the 2-year follow-up. Compliance to osteoporosis medications as estimated by the medication possession ratio (MPR) was 72.8 ± 34.5% at 2 years with patients maintaining good compliance (MPR ≥ 80%) for an average of 20.2 months (95% CI 19.3-21.1).

CONCLUSION

Our report provides the first compelling evidence of the potential success of a secondary fracture prevention program from an Asian country. The ultimate success of the program will be determined by fracture outcomes and cost effectiveness, but in the interim, clear evidence of enhanced assessment and treatment rates has been demonstrated.

Influence of the Flo-Dynamics Movement System intervention on measures of performance in older persons

Background

Fall-related injuries associated with aging are a serious clinical and economic problem. The Flo-Dynamics Movement System© (FDMS), which consists of eight movements with a water-filled device, may be a useful low-impact exercise suited for older persons. This study investigated the effects of the FDMS regimen with the Wun-Jo™ trainer on measures of strength, flexibility, and balance in older individuals.

Methods

In a quasi-experimental study, 15 healthy subjects aged 61–79 years participated in an FDMS exercise program with the Wun-Jo trainer, consisting of three weekly 30-minute sessions. The following measures were assessed pretraining and after 8 weeks of training: knee flexor and extensor isokinetic strength; grip strength; the Short Physical Performance Battery; functional reach; and low back and hamstring flexibility. Data were analyzed using repeated measures analysis of variance, with statistical significance set at the P ≤ 0.05 confidence level.

Results

Sit and reach test scores significantly increased (+21%) from baseline to week 8 (P < 0.001). Forward-left functional reach testing significantly increased (P = 0.012), while forward-right functional reach testing did not change (P = 0.474). Both left-lateral (P = 0.012) and right-lateral (P = 0.036) functional reach scores improved. Grip strength increased in both the left (+11.9%) and right (+14.5%) hands (P < 0.001 for each). Isokinetic knee extension at 60° per second increased for the left (+15.6%) and right (+17.6%) significantly (P = 0.001 for each). Isokinetic knee flexion at 60° per second significantly increased for both the left (+43.2%, P = 0.010) and right (+41.7%, P < 0.001). Time to complete the ten-repetition chair stand decreased significantly (−31%, P = 0.004). The 8-feet walk time also significantly decreased (−21.6%, P < 0.001).

Conclusion

Participating in the FDMS with the Wun-Jo device may improve balance, low back and hamstring flexibility, walking speed, and knee extensor/flexor and grip strength in older individuals. FDMS training provides an alternative to traditional exercise and offers an effective strategy to increase functional ability in the elderly.

The influence of the practice of physical activity on the quality of life, muscle strength, balance, and physical ability in the elderly

INTRODUCTION: Ageing has become a huge public health challenge due to the need to find solutions for improving quality of life. OBJECTIVE: This study aimed to assess quality of life, muscle strength, balance and physical capacity among elderly practitioners and non-practitioners of physical activity. MATERIALS AND METHODS: An observational, cross-sectional study was carried out involving 74 elderly individuals in the city of Santos (state of São Paulo, Brazil), divided into two groups: practitioners and non-practitioners of physical activity. The International Physical Activity Questionnaire was used for the classification of the participants. The generic SF-36 questionnaire was used to assess quality of life. The Berg scale was used for the analysis of balance. Dynamometry was used for the muscle strength test. The six-minute walk test was used for the assessment of physical capacity. RESULTS: Significant differences were found between elderly practitioners and non-practitioners of physical activity regarding quality of life (p = 0.001), muscle strength (p = 0.001), balance (p = 0.001) and physical capacity (p = 0.001). The data also showed that aspects of quality of life were strongly correlated with physical capacity among the non-practitioners of physical activity (r = 0.741). CONCLUSION: Elderly individuals in the city of Santos (Brazil) who practice physical activity have better quality of life, muscle strength, physical capacity and balance in comparison to those who do not practice physical activity.

Massage Therapy Produces Short-term Improvements in Balance, Neurological, and Cardiovascular Measures in Older Persons

Background:

Falls are the primary cause of accidental death in older persons, producing increased morbidity, decreased independence, and billions in medical costs annually. Massage therapy (MT) may produce adaptations that decrease risk of falling. If MT can improve stability in older persons, it may provide a new intervention for this issue.

Purpose:

Determine the acute effects of a 60-minute MT treatment on static and functional balance, neurological measures, heart rate, and blood pressure in healthy, older individuals.

Setting:

Laboratory

Research Design:

A 2 by 4 (treatment by time) mixed factorial experimental design for the cardiovascular and postural control variables; independent variables were treatment with two levels (control, MT) and time with four levels (pretreatment baseline, immediate post-treatment, 20-minute post-treatment, 60-minute post-treatment). Neurological measures utilized a 2 by 2 mixed design, with testing conducted pre- and 60-minutes post-treatment.

Participants:

Thirty-five healthy, older volunteers (19 male and 16 female; ages 62.9 ± 4.6).

Intervention:

A 60-minute full-body therapeutic massage. The control group rested quietly in the treatment room.

Main Outcome Measures:

Static (double-legged) and functional (single-legged) postural control with eyes-open and eyes-closed; Hoffmann-reflex measures; heart rate, and systolic and diastolic blood pressure.

Results:

MT significantly decreased rectangular displacement area in both the eyes-open and eyes-closed, double-legged stance conditions (p < 0.05); displacement velocity in both eyes-open conditions (p < .05); and systolic and diastolic blood pressure (p < .05), while increasing heart rate (p < .05). MT also significantly lowered H_max/M_max ratios compared to controls (p = .002). Decreased H_max/M_max measures were correlated to improved stability.

Conclusions:

A single, 60-minute, full-body massage therapy treatment was shown to have a stabilizing effect on measures of static and dynamic balance and physiological factors related to stability in older adults. MT should be investigated as a potential intervention to decrease falls in older individuals.

Immediate effects of bilateral grade III mobilization of the talocrural joint on the balance of elderly women

OBJECTIVE

The purpose of this study was to evaluate the immediate effects of a single treatment session of bilateral grade III mobilization of the talocrural joint on the balance of elderly women.

METHODS

Thirty-two elderly women (age, 65-80 years) with low physical activity levels completed balance evaluation using baropodometry, the Functional Reach Test and the Timed Up and Go Test, and plantar flexion and dorsiflexion range of motion (ROM), before and immediately after the mobilization (n = 16) or sham (n = 16). Each subject was submitted to a total of twelve 30-second grade III mobilizations, 6 for each ankle, in a single treatment session.

RESULTS

No significant difference was found for intragroup and intergroup comparisons in the balance of elderly women during the following evaluations: Functional Reach Test (P = .851), Timed Up and Go Test (P = .653), anteroposterior oscillation with eyes opened (P = .333) and with eyes closed (P = .652), and mediolateral oscillation with eyes opened (P = .486) and with eyes closed (P = .602). In addition, no significant difference was observed in right (P = .881) and left (P = .060) plantar flexion ROM and in right (P = .540) and left (P = .341) dorsiflexion ROM.

CONCLUSION

The results of this study suggest that a single session of bilateral grade III mobilization of the talocrural joint does not immediately improve balance and ROM in elderly women with low physical activity levels.

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

OBJECTIVES

To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home.

DESIGN

Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website.

SETTING

Residents in metropolitan Sydney, Australia.

PARTICIPANTS

Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran's Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises.

INTERVENTIONS

Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months.

MAIN OUTCOME MEASURES

Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily living activities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass.

RESULTS

After 12 months' follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls.

CONCLUSIONS

The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry 12606000025538.