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Melo RS, Cardeira CSF, Rezende DSA, Guimarães-do-Carmo VJ, Lemos A, de Moura-Filho AG. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0291193. [PMID: 37683025 PMCID: PMC10490910 DOI: 10.1371/journal.pone.0291193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists. OBJECTIVE Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs. METHODS Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses. RESULTS 3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence. CONCLUSIONS Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.
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Affiliation(s)
- Renato S. Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | | | | | - Andrea Lemos
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Alberto Galvão de Moura-Filho
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Lieberz D, Borgeson H, Dobson S, Ewings L, Johnson K, Klaysmat K, Schultz A, Tasson R, Borstad AL. A Physical Therapy Mobility Checkup for Older Adults: Feasibility and Participant Preferences From a Discrete Choice Experiment. J Patient Cent Res Rev 2022; 9:24-34. [PMID: 35111880 PMCID: PMC8772607 DOI: 10.17294/2330-0698.1874] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
PURPOSE Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment. METHODS Adults over 55 years of age were recruited from the community. In the study's first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the second phase, a new sample of older adults (>55 years old) were educated about the Mobility Checkup and then completed a discrete choice experiment to determine their preferences regarding 4 attributes of this care model: cost, visit duration, desired education topic, and style of educational graphic. RESULTS Each study phase was completed by 31 participants. Of the 6 feasibility criteria, 5 were met. Visit duration exceeded the 60-minute criteria for 13 of the 31 participants. Still, 91% of participants were very satisfied with the Mobility Checkup. Ability to transition positions identified preclinical mobility disability most frequently. A 30-minute visit with no out-of-pocket cost was deemed preferred. CONCLUSIONS Older adults value knowing what physical performance measurements predict about their general health. Transitions should be evaluated as part of a Mobility Checkup for older adults. Clearly conveyed cost of health care service is important to older adult consumers.
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Affiliation(s)
- Dalerie Lieberz
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | | | | | - Lindsey Ewings
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | | | - Kori Klaysmat
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | - Abby Schultz
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
| | - Rachel Tasson
- Department of Physical Therapy, The College of St. Scholastica, Duluth, MN
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Feng C, Adebero T, DePaul VG, Vafaei A, Norman KE, Auais M. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther 2022; 102:6383647. [PMID: 34636923 DOI: 10.1093/ptj/pzab236] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
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Affiliation(s)
- Chengying Feng
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Tony Adebero
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
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Effects of Ai-Chi Practice on Balance and Left Cerebellar Activation during High Working Memory Load Task in Older People: A Controlled Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312756. [PMID: 34886482 PMCID: PMC8656797 DOI: 10.3390/ijerph182312756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Normal aging is associated with balance and working memory decline. From a neurobiological standpoint, changes in cerebellar functional plasticity may mediate the decline in balance and working memory for older adults. Mounting evidence suggests that physical activity is beneficial for decreasing aging effects. Previous studies have focused on land-based physical activity and research concerning the aquatic environment is scarce. This study investigated the effectiveness of Ai-Chi on balance abilities and cerebral activation during a high working memory load task among community-dwelling older people. METHODS A total of 19 people aged 65-86 years were allocated to receive Ai-Chi practice (n = 6), structured on-land Ai-Chi practice (n = 7) or guided-imagery of Ai-Chi practice (n = 6) for a bi-weekly, 30-min exercise session for 12 weeks. Balance was measured by the Tinetti balance sub-test and working memory was measured by the N-back test during functional-MRI scan. RESULTS The Ai-Chi practice group presented a significant change in balance between pre and post intervention (balance t = -4.8, p < 0.01). In the whole-brain analysis, during high working memory load task, the Ai-Chi practice group presented a decrease in left cerebellar activation. Region of interest analyses yielded similar results by which pre-cerebellar activation was higher than post-intervention (t = 2.77, p < 0.05). CONCLUSIONS Ai-Chi is an available, non-invasive intervention method that may serve as a tool to improve cerebellar activation that in turn might improve balance. In addition, our findings may provide new insights into the neuronal mechanisms that underlie both motor and cognitive abilities.
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Effects of aquatic therapy on balance in older adults: a systematic review and meta-analysis. Eur Geriatr Med 2021; 13:381-393. [PMID: 34817841 DOI: 10.1007/s41999-021-00577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Balance is a key component of movement for daily activities, especially in older adults. Previous studies examining aquatic therapy as an effective way for improving balance have yielded inconsistent findings. The current systematic review and meta-analysis investigated the effectiveness of aquatic therapy on balance among older adults. METHODS Sources include Cochrane Central Register of Controlled Trials, Medline, ISI Web of Science, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Randomized controlled or cross-over trials published by Feb 2020 were included following pre-determined search and selection criteria. Data extraction was performed by two researchers independently using a pre-determined data extraction form. Methodological quality was assessed by two reviewers using the PEDro scale which was used to rate trials according to criteria such as concealed allocation, blinding, and intention-to-treat analysis. Furthermore, meta-analysis was conducted where possible. This review was registered at PROSPERO CRD42018118382. RESULTS Fifteen trials with 385 healthy participants aged 50 or over were included. Results showed that aquatic therapy had a significant effect on dynamic balance (SMD, - 1.13; 95% CI, [- 1.45 to (- 0.82)]; I2 = 77%). The analysis indicated that aquatic therapy improved balance ability compared to controls. CONCLUSIONS Aquatic therapy has a positive impact on dynamic balance in older adults. However, further high-quality and appropriately powered studies are required to confirm this assertion.
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Yoo JH. The psychological effects of water-based exercise in older adults: An integrative review. Geriatr Nurs 2020; 41:717-723. [PMID: 32451156 DOI: 10.1016/j.gerinurse.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
Although many review studies have been conducted on the physical benefits of water-based exercise, review studies on its psychological benefits are scarce. Thus, the aim of this integrative review was to explore the psychological effects of water-based exercise in older adults. Studies were included if they examined the psychological effects of water-based exercise in individuals aged 60 or older. The initial database search yielded 3861 studies. Duplicates and irrelevant studies were excluded by assessing titles and abstracts. Two additional studies were identified through ancestry searches. A total of 18 studies met the criteria. This review's findings suggest that water-based exercise can effectively improve individuals' quality of life, mood, depression, anxiety, tension, and fall efficacy. In addition, findings show that water-based exercise is feasible for both healthy older adults and those with chronic disease.
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Affiliation(s)
- Jee-Hye Yoo
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104, USA.
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Ku PH, Chen SF, Yang YR, Lai TC, Wang RY. The effects of Ai Chi for balance in individuals with chronic stroke: a randomized controlled trial. Sci Rep 2020; 10:1201. [PMID: 31988384 PMCID: PMC6985180 DOI: 10.1038/s41598-020-58098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Pei-Hsin Ku
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Szu-Fu Chen
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ta-Chang Lai
- Department of Neurology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC.
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC.
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