A Randomized Controlled Trial of an Enhanced Balance Training Program to Improve Mobility and Reduce Falls in Elderly Patients
ABSTRACT To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems.
Prospective, single-blind, randomized, controlled trial.
District general hospital.
One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale (BBS) score of less than 45.
Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance. The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems.
Ten-meter timed walk test (TWT), BBS, Frenchay Activities Index (FAI), Falls Handicap Inventory (FHI), and European Quality of Life questionnaire (Euroqol) measured at 6, 12, and 24 weeks after intervention.
The mean age +/- standard deviation of subjects was 82.7 +/- 5.6, and baseline characteristics were comparable between the groups. Both groups showed improvements in TWT (intervention: 22.5-16.5 seconds, P =.001; control: 20.5-15.8 seconds, P =.054), BBS (intervention: 33.3-42.7, P =.001; control: 33.4-42.0, P <.0001), FAI (18-21, P =.02 in both groups), FHI score (intervention: 31-17, P =.0001; control: 33-17, P =.0001) and Euroqol score (intervention: 58-65, P =.04; control: 60-65, P =.07). There were no intergroup differences at any time. More patients reported increased confidence in walking indoors (36% vs 28%; P =.04) and outdoors (27% vs 18%; P =.02) in the enhanced balance-training group.
Exercise programs significantly improve balance and mobility in patients with balance problems, independent of strategy. Enhanced balance training may, in addition, improve confidence and quality of life but needs further investigation.
- SourceAvailable from: bcnpb.ac.th
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- "However, only 3 out of 28 studies reviewed examined the effects of weighted vest on mobility, suggesting that more studies that compare weighted vest with other standardized physical activity programs are needed to recommend guidelines on the use of weighted vest in enhancing mobility in older adults. Older persons who participated in balance training showed significant improvement in walking speed and balance (Kammerlind, Hakansson, & Skogsberg, 2001; Steadman, Donaldson, & Kalra, 2003; Wolf et al., 2001). An approximately 10% increase in walking endurance was achieved by regular exercise training (Rubenstein et al., 2000), with ground walking noted as more effective than treadmill training (Marsh et al., 2006). "
ABSTRACT: Purpose: The purposes of this review were to provide an updated report of intervention studies designed to enhance mobility in older adults and discuss the strengths and limitations of existing intervention studies and their implications for practice.Data sources: Medline, CINAHL, and PsychInfo were searched to identify original research articles reporting interventions for promoting mobility in community-dwelling older adults.Conclusion: Effective interventions for enhancing mobility in older adults include walking, aerobic exercise, and resistance training focusing on strength, balance, and flexibility. Group-based interventions show significant beneficial effects in increasing mobility. To obtain significant effects of physical activity interventions, the patient should participate in the exercise programs for at least 12 weeks. Strengths of existing clinical trials for promoting mobility in older adults include testing of various types of physical activity and training interventions and the use of an experimental design with a control group. The major challenges of creating mobility enhancement recommendations for older adults include detailing a mobility enhancement program will delay disability, creating a specific program dose for different populations by gender and ethnicity, and developing culturally appropriate mobility enhancement programs to improve adherence over time.Implications for practice: Prescribing regular physical activity including aerobic exercise and resistance training in a primary care setting can be a beneficial approach to minimize progression of impaired mobility in older adults. The typical dose of the physical activity prescription is 20–60 min of aerobic activity three times weekly. Adherence to mobility enhancement recommendations by older patients can be followed up by in-person interview or use of mobility monitoring tools such as exercise diary or log.Journal of the American Academy of Nurse Practitioners 01/2009; 21(2):95 - 100. DOI:10.1111/j.1745-7599.2008.00390.x · 0.87 Impact Factor
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- "Randomized controlled exercise interventions to reduce falls and the risk factors for falling have been successful in improving the balance of aged people with high risk for falling (Barnett et al., 2003; Brouwer et al., 2003; Song et al., 2003; Nitz and Low Choy, 2004), while others have not (Rubenstein et al., 2000; Latham et al., 2003; Lord et al., 2003; Steadman et al., 2003). Only a few randomized controlled multifactorial fall prevention studies including assessment of the effects of the intervention on postural control have been conducted among the community-dwelling aged. "
ABSTRACT: The purpose of the study was to assess the effects of 12-month risk-based multifactorial fall prevention program on postural control of the aged. Five hundred and ninety-one (97%) eligible subjects were randomized into an intervention group (IG) (n=293) and a control group (CG) (n=298). The effects of the program were measured on standing, dynamic, and functional balance. In standing balance, the velocity moment of semi-tandem standing decreased in IG (median change -0.54 mm(2)/s) but increased in CG (+3.84 mm(2)/s) among all women (p=0.011) and among the women aged 65-74 years (-1.65 mm(2)/s and +2.80 mm(2)/s, correspondingly) (p=0.008). In a dynamic test, performance distance tended to decrease in IG (-26.54 mm) and increase in CG (+34.10mm) among all women (p=0.060). The women aged 75 years or over, showed marginally significant differences between the groups as regards changes in performance time (-2.66 s and -0.90 s) (p=0.068) and distance (-92.32 mm and +76.46 mm) (p=0.062) of the dynamic balance test in favor of IG. Men showed no significant differences in the changes between the groups in any balance measures.Archives of gerontology and geriatrics 11/2007; 48(1):22-7. DOI:10.1016/j.archger.2007.09.006 · 1.53 Impact Factor
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- "Regular balance training exercises for a period as short as 9 weeks improved postural control in a study group of persons aged 70–75, as measured by various clinical tests and dynamic posturography, when compared to age-matched control (Ledin et al 1991). A 6-week enhanced balance training program consisting of a series of tasks of increasing diffi culty which are related to functional balance versus " standard " physical therapy for adults with balance and mobility defi cits (Steadman et al 2003) reported positive results in a sample of 199 older adults. We could fi nd no evidence dealing with the dose or duration, of group balance classes. "
ABSTRACT: To determine the effectiveness of 8-week group functional balance training classes on balance outcomes in community-dwelling veterans at risk for falls. Pre-test, post-test using retrospective data. VISN 8 Patient Safety Center at James A. Haley Veterans Hospital in Tampa, FL, USA. Fifty one community living veterans with mean age of 78 at risk for falls. Participants received a weekly 1-hour functional balance training class for 8 weeks in a small group setting (4-5 participants). Pre and post intervention measures included Berg Balance Scale, Limits of Stability (LOS) and modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Eighty four percent of the participants completed 5 or more weekly classes. Peripheral neuropathy was the most common risk factor among the participants. There was a significant improvement in the Berg (p < 0.0001) and Composite Reaction Time (p < 0.0004) after the intervention. An eight week group functional balance training class was safe and effective in improving balance outcomes in a cohort of elderly veterans at risk for falls.Clinical Interventions in Aging 02/2007; 2(4):655-60. · 1.82 Impact Factor