Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial. Abstract. Background Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. Objective This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction.
Design This was a community- based, randomized controlled trial with assessors blinded to group allocation. Participants Study participants were older people who reported concerns about their balance but remained community ambulant (n=2. After a comprehensive balance assessment, those classified as having mild balance dysfunction (n=1. Intervention Participants in the intervention group (n=8. Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=8. Outcome Measures Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6- month reassessment.
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Results After 6 months, the intervention group (n=5. Functional Reach Test (mean difference=2. There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (2. Limitations Loss to follow- up (2. Conclusions A physical therapist–prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.
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Balance is defined as the ability to maintain the projection of the body's center of mass within limits of the base of support, as in standing or sitting, or in transit to a new base of support, as in walking. Balance control is complex and multifactorial.
Physiological changes related to aging include reduction in muscle strength,2 joint range of motion, reaction time, and changes in sensory systems. These factors, combined with pathology affecting these systems, potentially have negative effects on older people's balance control and may lead to balance dysfunction of varying severity.
Anorexia nervosa describes an eating disorder characterized by low body weight and body image distortion. Anorexia is a complex condition, involving psychological. Last updated: 15 September 2016. This is version 10.50 of the manual to the home and professional versions of X
Management of older people's balance dysfunction plays a key role in fall prevention. Impaired balance and reaction time, as well as loss of lower- limb muscle strength, have been identified as important risk factors for falls in older people. These factors have been shown to be amenable to interventions that can be carried out in the community setting. Published trials have shown that exercise interventions with balance and muscle strengthening components are effective in reducing falls. Most published studies evaluating effectiveness of exercise programs have either targeted “healthy, active older people,”1. These samples include frail older people with multiple functional limitations,1.
Parkinson disease,2. Falls often are used as a trigger to review risk factors (including balance) to determine whether interventions are needed. However, there has been recent interest in approaches to identifying problems contributing to falls before balance impairment becomes more marked and a fall occurs.
Curb and colleagues described a need for tests to discriminate performance on the “gradient of functioning at the upper end of the functional spectrum.”3. Using responsive tests of balance performance to identify mild levels of balance impairment could meet this need and identify people who without intervention would be likely to progress to becoming a “faller.” Furthermore, from a health promotion and prevention perspective, an exercise intervention introduced when balance dysfunction has recently developed or is of a mild level of severity may be more effective, less expensive, or both,3. There is a lack of research into older people with mild levels of balance dysfunction, and the effectiveness of exercise interventions in this group is unknown. Therefore, the current study aimed to investigate the effectiveness of a personalized, home- based exercise program in reversing older people's mild balance dysfunction.
The hypothesis tested in this study was that a home exercise program is effective in improving balance performance of older people with identified mild balance dysfunction. Method. This study was a randomized controlled trial.
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Clinical and laboratory measures of balance, mobility, gait, and muscle strength were assessed at baseline and at a 6- month reassessment. Participants in the intervention group underwent a personalized, home- based exercise program prescribed by a physical therapist, and participants in the control group continued with their usual activities. Participants. The sample consisted of 2. Recruitment started in February 2.
September 2. 00. 7. Participants were recruited from metropolitan Melbourne, Australia, by advertising in newspapers and newsletters, as well as through presentations by researchers to community groups of older people. Initially, the project targeted recruitment through veterans' and war widows' agencies.
At later stages, recruitment was opened up to include all people aged 6. Eligible participants for this trial were identified by a 2- step process. First, participants were screened prior to the baseline assessment to determine whether they met inclusion criteria. Second, participants were screened in a comprehensive balance assessment, and those who were identified as having mild balance dysfunction were eligible to be included in the trial. Inclusion criteria were being aged 6. Presence of balance concerns as an inclusion criterion was based on participants' positive response to the question: “Are you concerned about your balance?”All participants who met the inclusion criteria then underwent a comprehensive balance assessment (details of individual measures are contained in the “Outcome Measures” section). Those who were identified through this assessment as having mild balance dysfunction were enrolled as study participants.
For the purposes of this study, the following criteria were used in classifying participants with mild balance dysfunction. Participants who had any abnormal scores on clinical measures (defined as worse than 1 standard deviation from the mean score published for older people who are healthy). For the clinical measures used for this purpose, cutoff scores to indicate mild balance dysfunction were: a Functional Reach Test (FRT) score of less than 2. Step Test score of less than 1. Five- Time Sit- to- Stand Test time of greater than 1.
Participants who had more than 3 abnormal scores on the laboratory measures on the Neuro. Com Balance Master force platform with long plate (Neuro.
Com International Inc, Clackamas, Oregon). Age and sex normative limits for these measures are available from a data set provided with the Neuro. Com system. From the 6 tests used from the Neuro. Com Balance Master (see below), 4. A small number (3 or fewer) of these scores being outside of normative limits was accepted as being indicative of normative balance performance, whereas 4 or more of the 4. Outcome Measures. The primary outcome measures of the trial were clinical and laboratory measures of balance performance, and the secondary outcome measures included measures of strength and mobility, activity level, health- related quality of life, and fear of falling.
Balance performance has been shown to be multidimensional, including domains of static balance, bilateral stance dynamic balance, and dynamic single- limb stance balance. Both clinical and computerized forceplate measures (assessed by Neuro.
Com Balance Master with long plate) of each of these domains of balance were included in the assessment, as there is some evidence that force platform measures may be more sensitive in identifying mild dysfunction. Given the exploratory nature of this study and in view of the lack of previous studies investigating exercise interventions in older people with mild balance dysfunction, a single primary outcome measure was not selected. Clinical measures (with retest reliability values from previous studies of older people reported for each test) included. The FRT, a test of dynamic bilateral stance balance.
The maximal distance (in centimeters) that a participant could reach forward horizontally was measured while maintaining balance with feet 1. The score for the worse side was reported (ICC>. The Five- Time Sit- to- Stand Test, a functional measure of lower- limb strength. The participant stood up and sat down as quickly as possible from a standard chair (4. ICC>. 8. 9). 3. Lower- limb muscle strength of individual muscle groups.
A handheld dynamometer (Nicholas Manual Muscle Tester, Lafayette Instrument Co, Lafayette, Indiana) was used to measure 3 groups of leg muscles bilaterally using the “break” method: hip abductors, quadriceps, and ankle dorsiflexors. The standardized strength measure for a muscle group was derived by dividing the average of the results of trials 2 and 3 by the participant's weight. The scores on the worse side were reported for the 3 groups of muscles (ICC>. Walking speed (meters per minute). The participant was asked to walk at his or her “comfortable walking pace” across a 1. Participants used a single- point stick if this was their usual gait aid (ICC>. The Neuro. Com Balance Master with long plate also was used to assess balance- related performance during 6 functional tasks.
High retest reliability of several of these tests has been reported previously (ICC>. Test procedures were performed with shoes removed and have been described previously by Vrantsidis and colleagues. The 6 functional tasks were. The Modified Clinical Test of Sensory Interaction on Balance (m. CTSIB), a measure of static balance.