Exercise Intervention RCT’s
Exercise Intervention RCT’s
Effect of Senior Dance (DanSe) on fall risk factors in older adults: a randomized controlled trial
Franco MR, Sherrington C, Tiedemann A, Pereira LS, Perracini MR, Faria CRS, Negrão-Filho RF, Pinto RZ, Pastre CM. Phys. Ther. 2020; ePub(ePub): ePub.
Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, Sao Paulo, Brazil.
(Copyright © 2020, American Physical Therapy Association)
DOI 10.1093/ptj/pzz187 PMID 31899491
BACKGROUND: Older people’s participation in structured exercise programs to improve balance and mobility is low. Senior Dance is an alternative option, as it may provide a safe and fun way of targeting balance.
OBJECTIVE: The aim was to investigate the effect of Senior Dance on balance, mobility, and cognitive function, compared with a control intervention.
DESIGN: The study was a randomized controlled trial. SETTING/PATIENTS: Eighty-two community-dwelling older people aged 60 years or over and cognitively intact were recruited in Brazil. INTERVENTION: Participants were randomly allocated to 2 groups, Senior Dance plus education (intervention group) and education alone (control group). The Senior Dance program consisted of 12 weeks of twice-weekly group-based dance classes. Participants in both groups attended a single 1-hour educational session on prevention of falls. MEASUREMENTS: The primary outcome was single-leg stance with eyes closed. Secondary outcomes were timed sit-to-stand test, standing balance test, timed 4-meter walk, and cognitive function tests, eg, Trail Making test and Montreal Cognitive Assessment.
RESULTS: Of the 82 participants randomized, 71 (87%) completed the 12-week follow-up. Single-leg stance with eyes closed (primary outcome) improved in the Senior Dance group (mean difference [MD] = 2.3 seconds, 95% CI: 1.1 to 3.6) compared to the control group at follow-up. Senior Dance group performed better in the standing balance tests (MD = 3.7 seconds, 95% CI: 0.6 to 6.8), were faster in the sit-to-stand test (MD = – 3.1 seconds, 95% CI: -4.8 to -1.4), and 4-meter walk test (MD = -0.6 seconds, 95% CI: -1.0 to -0.1). There were no significant between-group differences for cognitive function tests. LIMITATIONS: Participants and therapists were not blinded.
CONCLUSION: Senior Dance was effective in improving balance and mobility but not cognitive function in community-dwelling older people.
Keywords Accidental Falls; Aging; Balance; Dance
Effects of Otago exercise combined with action observation training on balance and gait in the old people
Leem SH, Kim JH, Lee BH. J. Exerc. Rehabil. 2019; 15(6): 848-854.
(Copyright © 2019, Korean Society of Exercise Rehabilitation)
DOI 10.12965/jer.1938720.360 PMID 31938708
This study aimed to investigate the effects of Otago exercise combined with action observation (AO) training on the balance, and gait in the old people to prevent falls in the community. A total of 30 old women participated and randomly assigned into three groups: AO plus Otago (n=10), Otago (n=10), or control (n=10). The AO plus Otago and Otago groups performed 50 min of strength training and balance exercises from the Otago Exercise Program 3 times a week for 12 weeks. The AO plus Otago group received an additional 20 min of training 3 times a week. We used the electronic muscle dynamometer to changes in strength, Timed Up and Go (TUG) test to evaluate dynamic balance, and the short version of the Falls Efficacy Scale-International was used to evaluate the fear of falls, and GAITRite was used to evaluate changes in the spatiotemporal parameters of walking. The muscle strength significantly increased in the AO plus Otago and Otago groups compared to the strength before training. The TUG test showed a significant improvement in the dynamic balance in both intervention groups. A significant increase was observed in the walking speed, cadence, step length, and stride length in both intervention groups. We also noted a significant change in the efficacy measures for falls. It is expected that Otago exercise combined with AO training will be used as an intervention method in hospital treatment programs and the old people facilities for preventing falls in the old people.
Old people; balance; Action observation; Gait; Otago exercise; Prevent falls
Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial
Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Skelton D, Bergland A. Osteoporos. Int. 2020; ePub(ePub): ePub.
Institute of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group)
DOI 10.1007/s00198-019-05256-4 PMID 31925473
Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise-program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture.
INTRODUCTION: Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes.
METHODS: This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis).
RESULTS: No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80 s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life.
CONCLUSION: Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures. TRIAL REGISTRATION: ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.
Exercise; Health-related quality of life; Osteoporosis; Physical fitness; Vertebral fracture
Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial
Taylor L, Parsons J, Taylor D, Binns E, Lord S, Edlin R, Rochester L, Del Din S, Klenk J, Buckley C, Cavadino A, Moyes SA, Kerse N. Trials 2020; 21(1): e46.
The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.
(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group – BMC)
DOI 10.1186/s13063-019-3949-4 PMID 31915043
BACKGROUND: Falls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively.
METHODS/DESIGN: This is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period. Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs. The trial commenced recruitment on 30 November 2018.
DISCUSSION: This study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.
Aged care; Exercise therapy; Falls; Long-term care; Nursing home; Randomised trials
Effects of tai chi on postural control during dual-task stair negotiation in knee osteoarthritis: a randomised controlled trial protocol
Wang X, Hou M, Chen S, Yu J, Qi D, Zhang Y, Chen B, Xiong F, Fu S, Li Z, Yang F, Chang A, Liu A, Xie X. BMJ Open 2020; 10(1): e033230.
Rehabilitation Department of the Affiliated 3rd Peoples’ Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China firstname.lastname@example.org.
(Copyright © 2020, BMJ Publishing Group)
DOI 10.1136/bmjopen-2019-033230 PMID 31900273
INTRODUCTION: Stair ascent and descent require complex integration between sensory and motor systems; individuals with knee osteoarthritis (KOA) have an elevated risk for falls and fall injuries, which may be in part due to poor dynamic postural control during locomotion. Tai chi exercise has been shown to reduce fall risks in the ageing population and is recommended as one of the non-pharmocological therapies for people with KOA. However, neuromuscular mechanisms underlying the benefits of tai chi for persons with KOA are not clearly understood. Postural control deficits in performing a primary motor task may be more pronounced when required to simultaneously attend to a cognitive task. This single-blind, parallel design randomised controlled trial (RCT) aims to evaluate the effects of a 12-week tai chi programme versus balance and postural control training on neuromechanical characteristics during dual-task stair negotiation.
METHODS AND ANALYSIS: Sixty-six participants with KOA will be randomised into either tai chi or balance and postural control training, each at 60 min per session, twice weekly for 12 weeks. Assessed at baseline and 12 weeks (ie, postintervention), the primary outcomes are attention cost and dynamic postural stability during dual-task stair negotiation. Secondary outcomes include balance and proprioception, foot clearances, self-reported symptoms and function. A telephone follow-up to assess symptoms and function will be conducted at 20 weeks. The findings will help determine whether tai chi is beneficial on dynamic stability and in reducing fall risks in older adults with KOA patients in community. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (#2018KY-006-1). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR1800018028.
balance intervention; dynamic stability; knee osteoarthritis; stair ascent; stair descent
A study protocol for a randomized controlled trial evaluating vibration therapy as an intervention for postural training and fall prevention after distal radius fracture in elderly patients
Wong RMY, Ho WT, Tang N, Tso CY, Ng WKR, Chow SK, Cheung WH. Trials 2020; 21(1): e95.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China. email@example.com.
(Copyright © 2020, Holtzbrinck Springer Nature Publishing Group – BMC)
DOI 10.1186/s13063-019-4013-0 PMID 31948477
BACKGROUND: Fractures of the distal radius are one of the most common osteoporotic fractures in elderly men and women. These fractures are a particular health concern amongst the elderly, who are at risk of fragility fractures, and are associated with long-term functional impairment, pain and a variety of complications. This is a sentinel event, as these fractures are associated with a two to four times increased risk of subsequent hip fractures in elderly patients. This is an important concept, as it is well established that these patients have an increased risk of falling. Fall prevention is therefore crucial to decrease further morbidity and mortality. The purpose of this study is to investigate the effect of low-magnitude high-frequency vibration (LMHFV) on postural stability and prevention of falls in elderly patients post distal radius fracture.
METHODS: This is a prospective single-blinded randomized controlled trial. Two hundred patients will be recruited consecutively with consent, and randomized to either LMHFV (n = 100) or a control group (n = 100). The primary outcome is postural stability measured by the static and dynamic ability of patients to maintain centre of balance on the Biodex Balance System SD. Secondary outcomes are the occurrence of fall(s), the health-related quality of life 36-item short form instrument, the Timed Up and Go test for basic mobility skills, compliance and adverse events. Outcome assessments for both groups will be performed at baseline (0 month) and at 6 weeks, 3 months and 6 months time points.
DISCUSSION: Previous studies have stressed the importance of reducing falls after distal radius fracture has occurred in elderly patients, and an effective intervention is crucial. Numerous studies have proven vibration therapy to be effective in improving balancing ability in normal patients; However, no previous study has applied the device for patients with fractures. Our study will attempt to translate LMHFV to patients with fractures to improve postural stability and prevent recurrent falls. Positive results would provide a large impact on the prevention of secondary fractures and save healthcare costs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03380884. Registered on 21 December 2017.
Distal radius fracture; Fall prevention; Postural stability; Randomized controlled trial; Vibration
Effects of training with a custom-made visual feedback device on balance and functional lower-extremity strength in older adults: a randomized controlled trial
Oungphalachai T, Siriphorn A. J. Bodyw. Mov. Ther. 2020; 24(1): 199-205.
Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Thailand. Electronic address: firstname.lastname@example.org.
(Copyright © 2020, Elsevier Publishing)
DOI 10.1016/j.jbmt.2019.03.018 PMID 31987545
INTRODUCTION: Training with a slow and sustained mechanical load, such as standing on one leg, is an effective method for improving balance and increasing lower-extremity strength. Also, visual feedback during motor learning is important in facilitating efficient postural responses and balance skills. In this study, a custom-made visual feedback device was invented to provide the training modality and program based on single-leg standing combined with augmented visual feedback training. This study aimed to investigate the effects of visual feedback training using the custom-made visual feedback device on balance and functional lower-extremity strength in older adults.
METHODS: Thirty-four independent older adults were randomly allocated to a training group (TG) and a control group (CG). The participants in the TG received training with the custom-made visual feedback device. The training duration was three sessions per week, for four weeks. The participants in the CG continued their routine activities. Balance (static and dynamic balances, and balance confidence) and functional lower-extremity strength were assessed pre- and post-training.
RESULTS: Improvements in static balance (sway velocity and limit of balance during one-leg standing with eyes open) and dynamic balance (directional control of limits of stability in the backward direction) were found after training in the TG compared with the CG. No significant differences in balance confidence or functional lower-extremity strength were found between groups after training.
CONCLUSION: In older adults, training with a custom-made visual feedback device could be used to improve both static and dynamic balances, but not balance confidence and
Lower-extremity strength; Older adults; Visual feedback training; balance
The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial
Ku PH, Chen SF, Yang YR, Lai TC, Wang RY. Sci. Rep. 2020; 10(1): e1201.
Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC. email@example.com.
(Copyright © 2020, Nature Publishing Group)
DOI 10.1038/s41598-020-58098-0 PMID 31988384
This study investigated the effectiveness of Ai Chi compared to conventional water-based exercise on balance performance in individuals with chronic stroke. A total of 20 individuals with chronic stroke were randomly allocated to receive either Ai Chi or conventional water-based exercise for 60 min/time, 3 times/week, and a total of 6 weeks. Balance performance assessed by limit of stability (LOS) test and Berg balance scale (BBS). Fugl-Meyer assessment (FMA) and gait performance were documented for lower extremity movement control and walking ability, respectively. Excursion and movement velocity in LOS test was significantly increased in anteroposterior axis after receiving Ai Chi (p = 0.005 for excursion, p = 0.013 for velocity) but not conventional water-based exercise. In particular, the improvement of endpoint excursion in the Ai Chi group has significant inter-group difference (p = 0.001). Both groups showed significant improvement in BBS and FMA yet the Ai Chi group demonstrated significantly better results than control group (p = 0.025). Ai Chi is feasible for balance training in stroke, and is able to improve weight shifting in anteroposterior axis, functional balance, and lower extremity control as compared to conventional water-based exercise.
Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial
Lurie JD, Zagaria AB, Ellis L, Pidgeon D, Gill-Body KM, Burke C, Armbrust K, Cass S, Spratt KF, McDonough CM. Phys. Ther. 2020; ePub(ePub): ePub.
University of Pittsburgh, Pittsburgh, Pennsylvania.
(Copyright © 2020, American Physical Therapy Association)
DOI 10.1093/ptj/pzaa023 PMID 31998949
BACKGROUND: Falls are the leading cause of injuries among older adults and trips and slips are major contributors to falls.
OBJECTIVE: Compare the effectiveness of adding a component of surface-perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy.
DESIGN: This was a multi-center, pragmatic, randomized, comparative effectiveness trial. SETTING: Treatment took place within 8 outpatient physical therapy clinics. PATIENTS: This study included 506 patients aged 65+ at high fall risk referred for gait/balance training. INTERVENTION: This trial evaluated surface-perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist’s discretion versus usual multimodal exercise-based balance training alone. MEASUREMENTS: Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year.
RESULTS: 211/253 (83%) of patients randomized to perturbation-training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation-training group had significantly reduced chance of fall-related injury (5.7% vs. 13.3%; relative risk 0.43, p < 0.01) but no significant reduction in the risk of any fall (28% vs. 37% ST; relative risk 0.78 p<0.07) compared to usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months, but no significant reduction when viewed over the entire first year (p=0.67). LIMITATIONS: The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design.
CONCLUSION: The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months post-treatment. Further study is warranted to determine the optimal frequency, dose, progression and duration of surface perturbation aimed at training postural responses for this population.
Accidental Falls; Balance; Gait: Gait Training; Rehabilitation