Comparing the effects of anticipatory postural adjustments focused training and balance training on postural preparation, balance confidence and quality of life in elderly with history of a fall

Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial

BACKGROUND

'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability.

OBJECTIVE

This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP).

METHODS

Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks.

RESULTS

WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR.

CONCLUSION

Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis

Objective

To present a systematic review of randomized controlled trials which summarizes the effects of community-based resistance, balance, and multi-component exercise interventions on the parameters of functional ability (e.g., lower extremities muscle strength, balance performance and mobility).

Methods

This PROSPERO-registered systematic review (registration no. CRD42023434808) followed the PRISMA guidelines. Literature search was conducted in Cochrane, Embase, Ovid Medline, PEDro, Pubmed, Science Direct, Scopus and Web of Science. We included RCTs that investigated the following interventions: lower extremity strengthening, balance and multi-component exercise interventions on ambulatory community-dwelling adults aged ≥65 years.

Results

Lower extremity strengthening exercises revealed significant effects on the strength of lower extremity, balance outcomes and mobility. Balance exercises reduce the rate of injurious falls, improve static, dynamic and reactive balance, lower extremity strength as well as mobility. Multi-component exercise training reduces medically-attended injurious falls and fallers, incidence of falls, fall-related emergency department visits as well as improves mobility, balance, and lower extremity strength.

Conclusion

Physical exercises are effective in improving the components of balance, lower extremity strength, mobility, and reducing falls and fall-related injuries. Further research on fall prevention in low-income countries as well as for older adults in vulnerable context is needed.

Evaluation of the durable effects of corrective exercises on the postural alignment and stability in hyperkyphotic elderly with a history of falls

Background

This study aimed to investigate the durability of the effects of corrective exercises on the postural alignment and stability of hyperkyphotic elderly with a history of falls. Balance disturbance and recurrent falls are directly related to changes in the alignment of physical posture and function of the elderly, and effective methods with durable effects on improving the postural stability of the elderly have always been under the attention of researchers.

Methods

This study was a randomized clinical trial, and the statistical population included the elderly referred to neurology clinics. According to the research inclusion criteria (hyperkyphotic elderly with a history of falls during the last six months), 30 elderly aged 60 to 75 years old were purposefully selected and randomly divided into two groups of corrective exercises and control. The experimental group performed an exercise program based on the Alexander posture correction technique. Both groups were evaluated with forward head angle, kyphosis, the timed up and go test, postural stability, and fear of falling tests in three phases. Data analysis was conducted using SPSS 21 software and the MANCOVA test and repeated-measures analysis of variance.

Results

Data analysis showed significant improvements in the variables of forward head (p = 0.007), kyphosis(p = .001), balance(p = 0.002), postural stability(p = 0.001), and fear of falling(p = 0.001) in the experimental group. Post-test comparisons between the experimental and control groups showed significant differences in all variables except for kyphosis(p > .05), and follow-up analysis also revealed significant differences in all variables, except for the variables of forward head and kyphosis(p > .05).

Conclusions

Although the effects of corrective exercises in the elderly decreased regarding spinal alignment after three months, more lasting effects were seen in functional balance, postural stability, and fear of falling, suggesting this strategy as a stimulus for more mobility and a lower risk of falling in the elderly. Therefore, when using corrective exercises, it is possible to apply these exercises for a longer period of time to achieve more durable outcomes, especially regarding spinal alignment.

Trial registration

This research was registered in the Iranian Registry of Clinical Trials (IRCT2016081529373N1, Date of registration: 19/04/2017).

Older adults can rely on an auditory cue to generate anticipatory postural adjustments prior to an external perturbation

To minimize the potential postural disturbance induced by predictable external perturbations, humans generate anticipatory postural adjustments (APAs) using visual information about a perturbation. However, it is unknown whether older adults can generate APAs relying on auditory information. Ten older adults received external perturbations (a) with visual information but no auditory information available, (b) without neither visual nor auditory information, (c) with both visual and auditory information available, and (d) participated in training with only auditory information available. In addition, they were tested again after 1 week of washout period. Electromyography activities of eight leg and trunk muscles and ground reaction forces were recorded and analyzed during the anticipatory and compensatory phases. Outcome measures included the latencies and integrals of muscle activities, and center-of-pressure displacements. After a short period of training, participants were able to rely on the auditory cue only to generate APAs close to that when the visual information was available. In addition, after 1 week of washout period, they were able to partially retain the skill to rely on auditory cues to generate APAs. The outcome provides a foundation for future studies focusing on utilizing auditory cues to optimize postural control in individuals who have balance or vision deficit.

Which Exercise Interventions Can Most Effectively Improve Reactive Balance in Older Adults? A Systematic Review and Network Meta-Analysis

BACKGROUND

Reactive balance is the last line of defense to prevent a fall when the body loses stability, and beneficial effects of various exercise-based interventions on reactive balance in older adults have been reported. However, their pooled evidence on the relative effects has yet to be described.

OBJECTIVE

To review and evaluate the comparative effectiveness of various exercise-based interventions on reactive balance in older adults.

METHODS

Nine electronic databases and reference lists were searched from inception to August 2021. Eligibility criteria according to PICOS criteria were as follows: (1) population: older adults with the mean age of 65 years or above; (2) intervention and comparison: at least two distinct exercise interventions or one exercise intervention with a no-exercise controlled intervention (NE) compared in each trial; (3) outcome: at least one measure of reactive balance; (4) study: randomized controlled trial. The main network meta-analysis was performed on data from the entire older adult population, involving all clinical conditions as well as healthy older adults. Subgroup analyses stratified by characteristics of participants (healthy only) and reactive balance outcomes (simulated slip or trip while walking, simulated forward falls, being pushed or pulled, and movable platform) were also conducted.

RESULTS

Thirty-nine RCTs (n = 1388) investigating 17 different types of exercise interventions were included in the network meta-analysis. Reactive balance training as a single intervention presented the highest probability (surface under the cumulative ranking (SUCRA) score) of being the best intervention for improving reactive balance and the greatest relative effects vs. NE in the entire sample involving all clinical conditions [SUCRA = 0.9; mean difference (95% Credible Interval): 2.7 (1.0 to 4.3)]. The results were not affected by characteristics of participants (i.e., healthy older adults only) or reactive balance outcomes.

SUMMARY/CONCLUSION

The findings from the NMA suggest that a task-specific reactive balance exercise could be the optimal intervention for improving reactive balance in older adults, and power training can be considered as a secondary training exercise.

Two Aspects of Feedforward Control During a Fencing Lunge: Early and Anticipatory Postural Adjustments

The present study investigated whether expertise in fencing influences the onset of postural preparation during the fencing lunge and how it changes under different performance conditions. We also questioned if the onset of feedforward control can be categorized into one of the postural phases: anticipatory or early postural adjustment. Eight elite fencers and nine physical education students performed an attack with a lunge in self-paced and reaction time conditions from three different initial stance widths. The onset of the center of pressure (COP) displacement and EMG activities for the tibialis anterior (TA) of both limbs were recorded. The results show that expertise in fencing delays the onset of the activity of TA of the front leg and the onset of COP displacement during fencing lunge performance in comparison to controls. Additionally, in contrast to the control group, fencers produce typical APA patterns in the activation of TA under different performance conditions, delayed reaction time in comparison to self-initiated lunging, and constant time of APA onset under different widths of stance. According to different times and functions of TA activity and COP displacement in lunging, we propose to address them as anticipatory postural adjustment and early postural adjustment, respectively.

The role of an auditory cue in generating anticipatory postural adjustments in response to an external perturbation

Anticipatory postural adjustments (APAs) are usually generated to minimize the potential postural disturbance induced by predictable external perturbations. Visual information about a perturbation is important for the generation of APAs, but whether people can rely on auditory information to generate APAs is unknown. The aim of this study was to investigate the role of an auditory cue in generating APAs when visual information is not available. Fifteen young adults participated in the study. They received external perturbations a) with visual information but no auditory information available, b) without neither visual nor auditory information, c) with both visual and auditory information available, and d) with only auditory information available. Electromyography (EMG) activities of eight leg and trunk muscles and displacements of the center-of-pressure (COP) were recorded and analyzed during the anticipatory and compensatory (CPAs) phases. Outcome measures included the latencies and integrals of muscle activities, COP displacements, and indices of co-contraction and reciprocal activation of muscles. The results showed that after a short training, participants were able to rely only on the auditory cue to generate APAs comparable to that when the visual information was available. In addition, a training effect was found such that the participants demonstrated stronger APAs and less demands for CPAs through the training trials. The outcome provides a foundation for future studies focusing on the utilization of auditory cues for postural control in older adults and individuals who have vision deficit.