Article

Swanenburg, J., de Bruin, E. D., Stauffacher, M., Mulder, T. & Uebelhart, D. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study. Clin. Rehabil. 21, 523-534

University of Groningen, Groningen, Groningen, Netherlands
Clinical Rehabilitation (Impact Factor: 2.24). 07/2007; 21(6):523-34. DOI: 10.1177/0269215507075206
Source: PubMed

ABSTRACT

To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance.
Randomized clinical trial.
University hospital physiotherapy department.
Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of -1.8 (0.8).
A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period.
Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health.
Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls).
This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.

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    • "Furthermore, exercise that challenges balance plays a particularly important role in preventing falls in older people (Sherrington et al. 2011;Gillespie et al. 2012). Moreover, further benefits are likely if in addition to improving balance, training programs for older individuals also target improvements in muscle strength and functional independence (Eyigor et al. 2007;Swanenburg et al. 2007;Giné-Garriga et al. 2010;Bird et al. 2011;Kuptniratsaikul et al. 2011). Interventions specifically designed to improve balance and strength in older people are expected to have important clinical implications.Costa et al. (2012)developed a Balance Exercises Circuit (BEC) program, a new comprehensive design that includes exercise stations that specifically challenge sensory inputs from mechanoreceptors as well as from the visual and vestibular systems. "
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    ABSTRACT: 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.
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    • "Twelve studies [7,24-26,29-31,33,35-38] recruited only participants known to be at high risk of falling. Six studies targeted people with specific characteristics including visual impairment, [31] osteoporosis/osteopenia, [35] acute hip fracture, [36] stroke, [29] malnourishment [38] and foot problems [25]. "
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    ABSTRACT: Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2 = 20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.
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    • "Whereas Carter et al. (2001) recorded insignificant differences between the observed group and control group in static and dynamic balance after 10 weeks of exercise intervention. Swanenburg et al. (2007) observed the effect of a three-month exercise programme that included training for muscular strength, coordination, balance, and endurance when accompanied with nutritional (protein) supplements. They mentioned that the combination of calcium/vitamin D and exercise/protein intervention programme significantly reduced the risk of fall and in addition, these effects lasted for up to 9 months after the end of the intervention programme. "

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