A Randomized Controlled Trial of an Enhanced Balance Training Program to Improve Mobility and Reduce Falls in Elderly Patients

ICL, Londinium, England, United Kingdom
Journal of the American Geriatrics Society (Impact Factor: 4.57). 07/2003; 51(6):847-52. DOI: 10.1046/j.1365-2389.2003.51268.x
Source: PubMed


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.

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    • "Similarly, Steadman et al. [7], who had a group of seniors for balance training consisting of a series of repetitive tasks of increasing difficulty, found that the program significantly improved balance and mobility of the sample. "
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    ABSTRACT: We aimed to analyze the effect of a physical therapy protocol on unilateral vestibular hypofunction and overall balance in elderly with vertigo. The study included nine subjects, four male subjects (68.5 +/- 11.09 years old) and five females (72.4 +/- 7.09 years old). It was used the performance-oriented Mobility Assessment (POMA), to evaluate the balance and the Unterberger - Fukuda test for analysis of unilateral vestibular dysfunction through rotations and displacements of the body. We developed and applied a structured physical therapy protocol, consisting of group exercises RESULTS: It was observed that after the protocol, all participants improved balance (33.9 +/- 5.1 vs. 47.3 +/- 7.6, p < 0.0001) and displacement (111.1 +/- 38.0 vs. 53.3 +/- 34.6, p = 0.0001). However, it was not found significant differences for rotation. The proposed protocol has contributed to an improvement in balance and vestibular dysfunction of the aged.
    Full-text · Article · Feb 2014 · International Archives of Medicine
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    • "Both balance [30,31] and resistance exercises [32] improve balance and reduce the frequency of falling. Few studies have addressed whether the fear of falling is significantly associated with overall functional performance, which is related to quality of life, especially in the elderly [29]. "
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    ABSTRACT: Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whether exercise programs decrease the fear of future falls in elderly patients who have fallen previously. A randomized controlled study was performed that included 65 elderly community-dwelling subjects who had fallen in the previous year. Subjects were randomized into two groups: an exercise group (EG, n = 36) and a control group (CG, n = 29). The EG participated in three exercise sessions per week for 12 weeks. Muscle strength, balance, agility, flexibility, and muscular endurance were measured at baseline and after 12 weeks. After the 12-week exercise program, the subjects in the EG demonstrated remarkable improvement in their walking speed, balance (p = 0.003), back strength (p = 0.08), lower extremity strength (p = 0.004), and flexibility (p < 0.001). When asked whether they were afraid of falling, more participants in the EG than in the CG responded "not at all" or "a little." The 12-week exercise program described here reduced the fear of falling (p = 0.02). It also improved the balance, flexibility, and muscle strength of the participants and was associated with improved quality of life.
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    • "Hass et al. reported a positive influence of balance and coordination training on gait initiation in older adults that were transitionally frail [37]. Our study is at variance, however, with the results from Steadman et al. (2003) who reported improvements in walking velocity of balance-impaired patients following a balance training programme [38]. Steadman et al., however, specifically included functional exercises that aimed to improve walking and leg strength in their exercise protocol. "
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    ABSTRACT: Motor learning research has had little impact on clinical applications and rarely extended to research about how older adults learn motor skills. There is consistent evidence that motor skill performance and learning can be enhanced by giving learners instructions that direct their attention. The aim of this study was to test whether elderly individuals that receive an external focus instruction during training of dynamic balance skills would learn in a different manner compared to individuals that received an internal focus instruction. This randomised trial included 26 older persons (81 +/- 6 years) that were training functional balance twice a week for the duration of 5 weeks. Learning outcomes were recorded after every training session. Weight shifting score and dynamic balance parameters (Biodex Balance System), components of the Extended Timed-Get-Up-and-Go test, five chair rises, and falls efficacy (FES-I) was assessed at baseline and post-intervention. Participation for training sessions was 94%. No differences between groups were found following 5 weeks of training for weight shifting score, dynamic balance index and dynamic balance time (p < 0.95, p = 0.16, p < 0.50), implying no learning differences between training groups. Extended Timed-Get-Up-and-Go components Sit-to-stand, p = .036; Gait initiation, p = .039; Slow down, stop, turnaround, and sit down, p = 0.011 and the Fes-I (p = 0.014) showed improvements for the total group, indicating that function improved compared to baseline. A 5-week balance training improved weight shifting scores and dynamic balance parameters as well as functional abilities. The observed improvements were independent from the type of attentional focus instructions. The findings provide support for the proposition of different motor learning principles in older adults compared to younger adults.
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