The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults

Effects of shuttle balance exercises on gait speed, postural control, and quality of life in older males: A randomized controlled trial

BACKGROUND AND PURPOSE

Enhancing physical function and quality of life in older adults at higher risk of falls is challenging because of the lack of established interventions. This study examines the impact of a 6-week balance training program using the shuttle balance device on gait speed, postural control, and quality of life in older men.

METHODS

This single-blinded randomized controlled trial was conducted in a research laboratory. Thirty-two participants aged ≥60 years were randomly assigned to either an experimental group (EG; n = 16) or a control group (CG; n = 14). The EG participated in a 6-week shuttle balance exercise program, while the CG maintained regular physical activity routines. The main outcome measures included gait speed (assessed via the timed up and go test), postural control (assessed via center of pressure data on a force plate), and quality of life (evaluated using the SF-36 questionnaire).

RESULTS

Post-intervention, the EG showed significant improvements compared with the CG (p < 0.05). The 95% confidence intervals for the differences between groups were as follows: closed eyes (CE) mean velocity (-39.07, -0.13), CE sway area (-48.86, -0.18), SF-36 total score (9.01, 16.81), SF-36 physical functioning (7.00, 24.81), SF-36 physical role functioning (1.80, 27.57), SF-36 pain (15.01, 36.82), SF-36 general health state (7.48, 26.08), SF-36 vitality (5.60, 28.35), and SF-36 mental health (0.21, 21.12).

DISCUSSION

A 6-week shuttle balance training program significantly improves postural control and quality of life in older males. These findings suggest the potential effectiveness of shuttle balance exercises in enhancing physical function and well-being in this population. Further research is needed to validate these findings and explore the long-term effects with larger sample sizes.

Improvements in Postural Stability, Dynamic Balance, and Strength Following 12 Weeks of Online Ballet-Modern Dance Classes for Older Women

Falls are the leading cause of injury-related deaths among older adults and affect women at disproportionate rates. Dance has been used to improve postural stability, balance confidence and strength of older adults, but in-person classes are often inaccessible. This quasi-experimental pre-mid-post design study investigates whether 12 weeks of online dance classes can improve postural stability, dynamic balance and strength of women aged 65 plus. 16 participants (median=74 years, IQR=6) recruited via convenience sampling completed 12 weeks of twice weekly 75-minute online dance classes. In-person pre, mid and post assessments used 30-second trials of quiet standing, Star Excursion Balance Test, 30-second Sitto-Stand and Calf-Raise-Senior. Significance was evaluated using Friedman's test with Wilcoxon Signed-Rank test post-hoc (p≤.05). Participants demonstrated a high attendance rate (median=87.5, IQR=4.2%). Decreased mediolateral sway was observed pre-mid in eyes closed (p=.003, r=.76) and foam (p=.02, r=.60) conditions, where the latter also produced decreased sway area (p=.015, r=.63). Greater dynamic balance was demonstrated when reaching laterally (pre-mid p=.008, r=.68; pre-post p=.008, r=.69) and posterior-laterally (pre-post p=.009, r=.75). Participants significantly improved their number of repetitions on the Calf-Raise Senior (mid-post p=.02, r=.60; prepost p=.015, r=.63). Online dance classes are engaging, accessible and effective in decreasing older women's risk of falls and maintaining their independence.

Compared Block Periodized and Non-Periodized Physical Activity Programs in Older Adults

BACKGROUND

The periodization of physical exercise to optimize objectives is common in competitive sports. However, physical exercise programs for older adults only sometimes present periodization in their programming. Therefore, this article aims to research the results of applying the sports periodized method to older adults.

METHODS

A total of 137 participants over 60 years old performed a physical exercise program; 71 participated in a multi-component non-periodized program as the Control Group (CG), and 66 participated in a program periodized in blocks as the Experimental Group (EG). The block periodization program was oriented to the development of strength and was carried out in 86 sessions thrice weekly for eight months. Anthropometric assessments were made using weight, height, Body Mass Index, and electrical bioimpedance; and functional evaluations were made through standardized tests: Short Performance Physical Battery (SPPB), Timed Up & Go (TUG), handgrip, and a two-minute stair test.

RESULTS

After the intervention, the EG significantly improved TUG, weight, and BMI. On the other hand, the CG showed significant improvements in fat weight, BMI, and the 2 min stair test. The SPPB did not show changes after the intervention.

CONCLUSION

The periodization of physical exercise for older adults does not significantly impact functional capacity in this population group.

Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people

Introduction

Sensory systems provide the necessary information for a motor response to be provided. In this sense, the objective of this study is to evaluate the effectiveness of a sensorimotor exercise program on proprioceptive acuity, balance, muscle strength, functional mobility and risk of falls in institutionalized elderly.

Methodology

56 participants (84.6 ± 8.4 years) were randomly distributed between the control (CG, n = 28) and intervention groups (IG, n = 28). The CG performed a protocol based on warm-up, muscle strengthening and warm down and the IG performed the same intervention, with the addition of sensorimotor exercises. Joint Position Sensation (JPS) was evaluated in both limbs at angles of 20° and 45°, balance, functional mobility, fear of falling in the elderly and muscle strength of quadriceps, hamstrings, adductors and abductors in both limbs, before and after the 12 weeks of intervention.

Results

Both groups showed gains in muscle strength. When analyzing functionality through Timed Up and Go (TUG), before and after for each group separately, both showed a significant difference (CG p = 0.002; IG p < 0.001). For the Short Physical Performance Battery (SPPB) variable, there were significant differences in IG in balance (p < 0.001), gait speed time (s) (p = 0.004) and sit-to-stand (p = 0.002). In JPS, significant differences were recorded for Absolute Error 45° Non-Dominant (p = 0.045) and Relative Error 45° Non-Dominant (p = 0.045) in the CG and Relative Error 45° Non-Dominant for IG (p = 0.018). In the Falls Efficacy Scale International (FES-I) variable there were significant improvements in the CG (p = 0.006) and in the GI (p = 0.002). However, only IG showed significant improvements (p = 0.013) for Activities-Specific Balance Confident (ABC) in a comparison between before and after the 12-week research period. When comparing the differences verified with the intervention between CG and IG, only balance SPPB (p < 0.001) and sit-to-stand SPPB (p = 0.022) showed significant values.

Conclusion

He effectiveness of sensorimotor exercises provides balance gain in the elderly (p < 0.001) and positively impacts their confidence (p = 0.013) when performing their duties. It is concluded that the protocol presented in its different levels of difficulty is effective and important for the quality of life of the institutionalized sedentary elderly.

What type of exercises should older adults engage in to improve fall efficacy and physical fitness related to falling?

This study aimed to examine the effects of exercise interventions developed over the past 10 years to prevent falls among older adults. Cochrane, PubMed, and Embase databases were systematically searched on November 3, 2022, using the following keywords: "elderly" or "aged" and "fall prevention exercise" and "randomized controlled trial." A total of 918 articles were retrieved, and finally, 18 studies were included in the meta-analysis. main conclusions were as follows: fall prevention exercises showed moderately positive effects on balance, gait, mobility, physical function, lower limb power, and strength, but low effects on proprioception, vision, and reaction speed. The effect sizes were highest when the intervention period was 1-24 weeks, time was 31-60 min, and frequency was thrice per week. Place of intervention (home, community, laboratory) and age (>75 years, <75 years) showed similarly moderate effect sizes. A combined program that includes balance, co-ordination, and resistance exercises is appropriate to improve fall-related fitness and fall efficacy in community-dwelling older individuals.

Change in gait speed and fall risk among community-dwelling older adults with and without mild cognitive impairment: a retrospective cohort analysis

BACKGROUND

Although slow gait speed is an established risk factor for falls, few studies have evaluated change in gait speed as a predictor of falls or considered variability in effects by cognitive status. Change in gait speed may be a more useful metric because of its potential to identify decline in function. In addition, older adults with mild cognitive impairment are at an elevated risk of falls. The purpose of this research was to quantify the association between 12-month change in gait speed and falls in the subsequent 6 months among older adults with and without mild cognitive impairment.

METHODS

Falls were self-reported every six months, and gait speed was ascertained annually among 2,776 participants in the Ginkgo Evaluation of Memory Study (2000-2008). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for fall risk relative to a 12-month change in gait speed.

RESULTS

Slowing gait speed over 12 months was associated with increased risk of one or more falls (HR:1.13; 95% CI: 1.02 to 1.25) and multiple falls (HR:1.44; 95% CI: 1.18 to 1.75). Quickening gait speed was not associated with risk of one or more falls (HR 0.97; 95% CI: 0.87 to 1.08) or multiple falls (HR 1.04; 95% CI: 0.84 to 1.28), relative to those with a less than 0.10 m/s change in gait speed. Associations did not vary by cognitive status (pinteraction = 0.95 all falls, 0.25 multiple falls).

CONCLUSIONS

Decline in gait speed over 12 months is associated with an increased likelihood of falls among community-dwelling older adults, regardless of cognitive status. Routine checks of gait speed at outpatient visits may be warranted as a means to focus fall risk reduction efforts.

Healthy aging reduces dynamic balance control as measured by the simplified Star Excursion Balance Test

BACKGROUND

Detecting and classifying factors that contribute to age-related balance decline are essential for targeted interventions. Dynamic postural tests that challenge neuromuscular balance control are important to detect subtle deficits that affect functional balance in healthy aging.

RESEARCH QUESTION

How does healthy aging affect specific components of dynamic postural control as measured by the simplified Star Excursion Balance Test (SEBT)?

METHODS

Twenty healthy younger (18-39 years) and twenty healthy older (58-74 years) adults performed the standardized simplified SEBT, which involved standing on one leg and reaching the contralateral leg as far as possible in the anterior, posteromedial, and posterolateral directions. Optical motion capture was used to quantify the maximum reach distance normalized by body height (%H) for three repeated trials in each direction per leg. Linear mixed effects models and pairwise comparisons of estimated marginal means were used to assess differences (p < 0.05) in normalized maximum reach distance by age group, reach direction, and leg dominance. Intersubject and intrasubject variability were also assessed by age group using coefficients of variation (CV).

RESULTS

Healthy older adults had less dynamic postural control compared to younger adults, with shorter reach distances in the anterior (7.9 %), posteromedial (15.8 %), and posterolateral (30.0 %) directions (p < 0.05). Leg dominance and sex did not significantly affect SEBT score for either age group (p > 0.05). Low intrasubject variability (CV<0.25 %) was found for repeated trials in both the older and younger participants. Therefore, the comparatively higher intersubject variability (Range CV=8-25 %) was mostly attributed to differences in SEBT performance across participants.

SIGNIFICANCE

Quantifying dynamic postural control in healthy older adults in a clinical setting is important for early detection of balance decline and guiding targeted and effective treatment. These results support that the simplified SEBT is more challenging for healthy older adults, who may benefit from dynamic postural training to mitigate age-related decline.

Responsiveness of Daily Life Gait Quality Characteristics over One Year in Older Adults Who Experienced a Fall or Engaged in Balance Exercise

Gait quality characteristics obtained from daily-life accelerometry are clinically relevant for fall risk in older adults but it is unknown whether these characteristics are responsive to changes in gait quality. We aimed to test whether accelerometry-based daily-life gait quality characteristics are reliable and responsive to changes over one year in older adults who experienced a fall or an exercise intervention. One-week trunk acceleration data were collected from 522 participants (65-97 years), at baseline and after one year. We calculated median values of walking speed, regularity (sample entropy), stability (logarithmic rate of divergence per stride), and a gait quality composite score, across all 10-s gait epochs derived from one-week gait episodes. Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined for 198 participants who did not fall nor participated in an exercise intervention during follow-up. For responsiveness to change, we determined the number of participants who fell (n = 209) or participated in an exercise intervention (n = 115) that showed a change beyond the LOA. ICCs for agreement between baseline and follow-up exceeded 0.70 for all gait quality characteristics except for vertical gait stability (ICC = 0.69, 95% CI [0.62, 0.75]) and walking speed (ICC = 0.68, 95% CI [0.62, 0.74]). Only walking speed, vertical and mediolateral gait stability changed significantly in the exercisers over one year but effect sizes were below 0.2. The characteristic associated with most fallers beyond the LOA was mediolateral sample entropy (4.8% of fallers). For the exercisers, this was gait stability in three directions and the gait quality composite score (2.6% of exercisers). The gait quality characteristics obtained by median values over one week of trunk accelerometry were not responsive to presumed changes in gait quality after a fall or an exercise intervention in older people. This is likely due to large (within subjects) differences in gait behaviour that participants show in daily life.

The minimal important change for measures of balance and postural control in older adults: a systematic review

The minimal important change and analogous terms (MIC) can provide a measure of change in health outcome variables that is associated with a level of importance for participant/patient. This review explores the availability of the MIC for different balance measures used with older adults in research and clinical settings. PubMed, ProQuest and Web of Science search engines were used and based on the inclusion and exclusion criteria, 11 studies were deemed suitable for data extraction and analysis. The results demonstrated that MIC is available for the following balance-associated tests: Berg Balance Scale, Timed Up and Go, Short Physical Performance Battery, BESTest and the Tinetti test. A range of MIC values were shown, reflective of different older adult health conditions, calculation methods and anchors used. It was also evident that the responsiveness of the test was not always available or appropriately determined, questioning the validity of the MIC value published. Greater research is needed to establish MIC for balance measurements for use with older adults with different health conditions, preferably using objective measures such as falls. The calculation of such statistics will improve the evaluation of intervention effectiveness.

Tai Chi for spatiotemporal gait features and dynamic balancing capacity in elderly female patients with non-specific low back pain: A six-week randomized controlled trial

BACKGROUND

Non-specific low back pain (NS-LBP) is a serious public health problem. Tai Chi is promising in reducing the risk of falls and alleviating symptoms in this population.

OBJECTIVE

To investigate the effect of Tai Chi on gait and dynamic balance in elderly women with NS-LBP.

METHODS

20 women (age > 65 yr.) with NS-LBP were randomly assigned to a Tai Chi group (n= 10) or a control group (n= 10). The Tai Chi group practiced Tai Chi exercise 3 times a week for 6 weeks. Each session lasted 60 minutes. Pain, spatiotemporal gait features and dynamic balancing capacity were assessed at 0 and 6 weeks.

RESULTS

Compared to the control group at 6 weeks, the Tai Chi group had a significant decrease in VAS (p= 0.027) and stride width (p= 0.019), significant improvement in gait velocity, stride length (p< 0.001). Regarding dynamic balance capacity, the Tai Chi group had significant improvements in anterior (Left: p= 0.001; Right: p= 0.038), postero-lateral (Left: p< 0.001; Right: p= 0.038), and postero-medial (Left: p= 0.015; Right: p= 0.018).

CONCLUSION

6-week Tai Chi can relieve pain and improve gait and dynamic balance in elderly women with NS-LBP, which suggests Tai Chi could be a promising rehabilitation intervention to reduce the risk of falls in this population.

Randomized Controlled Trial of Group Exercise Intervention for Fall Risk Factors Reduction in Nursing Home Residents

OBJECTIVE

The aim of this study was to assess the effectiveness of a multidimensional exercise intervention on improving fall risk deterrent factors, such as overall strength and flexibility in nursing home residents.

METHODS

A multi-centre, randomized controlled trial was finally utilized in 40 older adults (>65 years) who were randomly allocated to the intervention or the control group (20 subjects in each). The intervention group attended an exercise program twice a week for eight weeks, to improve functional mobility. The control group did not receive any intervention. Measurements before and after intervention included the Hand Grip Strength (HGS) testing, the Sit-to-Stand test (SST), the Back Scratch Test (BST), and the Sit-and-Reach test (SRT).

RESULTS

MANOVA revealed significant time effects, V = 0.336, F(6, 33) = 2.78, p = 0.027, partial η² = 0.336; group effects, V = 0.599, F(6, 33) = 8.22, p < 0.001, partial η² = 0.599; and group*time interaction, V = 0.908, F(6, 33) = 54.52, p < 0.001, partial η² = 0.908. A subsequent univariate analysis did not reveal a significant time effect for any variable (p > 0.05). Significant group effects were observed only for SRT (p < 0.05). Significant group*time interactions were observed for all the examined variables (p < 0.05). Dependent t-tests showed that the older adults in the exercise group were significantly improved in all the examined parameters (p < 0.05). Except for SRT (p > 0.05), all the other parameters significantly deteriorated in the control group (p < 0.05).

CONCLUSIONS

Significant improvements were demonstrated in strength and flexibility among nursing home residents following an eight-week group exercise training program.

Musculoskeletal Biomarkers Response to Exercise in Older Adults

Exercise is an essential component of any good health style, being particularly important for older adults to counteract the effects of aging, including sarcopenia and osteoporosis, which can result in lower fall probability. Exercise programs for older adults are especially designed for that population. A rigorous evaluation of those programs is necessary to assure most benefit is achieved. Serum biomarkers of proteins intrinsic to musculoskeletal homeostasis could contribute objectively to the assessment of the benefits of exercise. In this work, in addition to the usual physical fitness and balance tests, ELISA assays quantified the serum levels of six proteins and one polysaccharide important for the homeostasis of muscle (troponin T and alpha-actinin), tendon/ligament (tenomodulin), cartilage (cartilage oligomeric matrix protein and hyaluronan) and bone (osteocalcin and sclerostin), before and after 8 weeks of an exercise program tailored to older adults, Stay Strong Stay Healthy, offered at a Community Center and at an Independent Senior Living facility. Statistical significance was determined by non-parametric tests (Wilcoxon Signed Ranks and Mann-Whitney U). Physical fitness and balance improved as expected along with a significant decrease in sclerostin, pointing to less inhibition of bone deposition. However, when considering each type of dwelling separately, older adults always saw a significant decrease of the isoform of troponin T associated with fast-twitch muscles, suggesting that daily levels of physical activity may also have a role in the benefit of older adults from exercise.

A Pilot Study of a Group Program Focused on Enabling Life Performance for Older Adults Living in the Community

Background: This study attempts to determine whether a program focused on improving literacy in daily living is effective in preventing physical frailty, and to compare standard treatments for physical frailty. Methods: This study was designed as a pilot intervention study involving two groups. Twenty-five older adults aged 65 to 85 in Ward A, Tokyo, were randomly assigned to the literacy group or the exercise group on a regional basis and were given a 60- to 90-minute program twice a month, eight times over four months. The literacy group mainly used video materials to monitor learning, and the exercise group used a multifactor exercise program. Results: The LSI-Z, GAS-L, Maximum 5 m walking time, and TUG tests showed the main effects before and after the intervention in both groups (p < 0.05, p < 0.01). The WHOQOL26, Maximum 5 m walking time, and TUG tests also showed the main effects across both groups (p < 0.05). Conclusion: Both programs, when implemented independently, showed specific effects on subjective well-being, occupational performance, and physical fitness. However, QOL and physical fitness were significantly higher in the exercise group than in the literacy group. These results should be considered with caution because of the limited sample size of this pilot study.

The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study

Background

The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA).

Methods

We enrolled 40 adults with SCD (20 younger adults aged 18–49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events.

Results

Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80–98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s).

Conclusion

The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.

Aerobic Exercise Combination Intervention to Improve Physical Performance Among the Elderly: A Systematic Review

The benefits of aerobic exercise for the elderly are well-known. They extend beyond cardiovascular changes and can reduce the inactivity-induced loss of strength, mobility, balance, and endurance that are vital for the safe performance of daily activities in older adults. However, the benefits of combined aerobic exercise with other exercises such as strength/resistance, multi-component and aerobic exercise remain unknown. The purpose of this study is to examine the effects of combined aerobic exercise on physical performance among the elderly, as opposed to single aerobic exercise. We searched four databases of SCOPUS, PubMed, EBSCOhost, and CINAHL Plus to find 18 articles that met criteria. Data was extracted using PICOs extraction tool and summarized using a narrative synthesis approach. Studies have shown that aerobics combined resistance/strength training (CEX), multi-component training (ME), and dance combined training has positive and significant effects on the physical performance (upper body strength and lower body strength, dynamic balance, fall risk, mobility, gait, agility, flexibility) of the elderly. CEX had additional benefits compared to aerobic training (AER) and resistance/strength training (RES) in gait speed, lower limb strength, and trunk fat. Furthermore, CEX was more effective than AER in improving sitting and stretching, elbow flexion, knee flexion, shoulder flexion and stretching, strength and body fat, function reach test, 30-s chair standing test and 6-min walking test, self-evaluation of body function. Therefore, the combination of multiple components contributes to the overall improvement in physical fitness of the elderly, thus preventing them from losing balance and reducing susceptibility to injury.

Clinical Trial Registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42021213147].

A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults

As aging continues to grow in our society, sarcopenia and associated fall risk is considered a public health problem since falling is the third cause of chronic disability. Falls are negatively related to functionality and independence and positively associated with morbidity and mortality. The cost of treatment of secondary injuries related to falls is high. For example, one in ten fall incidents leads to bone fractures and several other comorbidities. As demonstrated by several experimental studies, adopting a more active lifestyle is critical for reducing the number of fall episodes and their consequences. Therefore, it is essential to debate the proven physical exercise methods to reduce falls and fall-related effects. Since muscle mass, muscle strength, bone density, and cartilage function may play significant roles in daily activities, resistance training may positively and significantly affect the elderly. This narrative review aimed to examine current evidence on existing resistance training using resistance machines and bodyweight or low-cost equipment for the elderly and how they are related to falls and fall-related consequences. We provide theoretical links between aging, sarcopenia, and falls linking to resistance training and offer practical suggestions to exercise professionals seeking to promote regular physical exercise to promote quality of life in this population. Exercise programs focusing on strength may significantly influence muscle mass and muscle strength, minimizing functional decline and risk of falling. Resistance training programs should be customized to each elderly according to age, sex, and other fundamental and individual aspects. This narrative review provides evidence to support recommendations for practical resistance training in the elderly related to intensity and volume. A properly designed resistance training program with adequate instructions and technique is safe for the elderly. It should include an individualized approach based on existing equipment (i.e., body weight, resistance machines). Existing literature shows that exercise performance towards 2-3 sets of 1-2 exercises per major muscle group, performing 5-8 repetitions or achieving intensities of 50-80% of 1RM, 2-3 times per week should be recommended, followed by training principles such as periodization and progression. Bearing this in mind, health and exercise professionals should combine efforts focusing on efficient strategies to reduce falls among the elderly and promote higher experiences of well-being at advanced stages in life.

Meta-Analysis of Elderly Lower Body Strength: Different Effects of Tai Chi Exercise on the Knee Joint-Related Muscle Groups

OBJECTIVE

To determine whether lower body strength such as keen extension and flexion strength may be improved by Tai Chi exercise in older adults from the perspective of evidence-based medicine.

METHODS

Databases of PubMed, Embase, and Cochrane Library were searched up to July 1, 2021. Randomized clinical trials are adopted to compare Tai Chi exercise with sedentary behavior or other low intensity exercise in terms of influence on lower body strength rehabilitation, especially keen extension and flexion strength in people aged over 60. A meta-analysis was performed to discuss outcomes of lower body strength, knee muscle strength, and knee extension/flexion strength.

RESULTS

A total of 25 randomized trials involving 1995 participants fulfilled the inclusion criteria. (1) Tai Chi exercise significantly improved elderly lower body strength (-0.54, [-0.81, -0.28], p < 0.00001, I ² = 74%), but there was no differential improvement in the strength of the knee joints (0.10, [-0.02, 0.23], p=0.11, I ² = 34%). (2) Elderly individual lower body strength declined with age, while this trend was suppressed by Tai Chi exercise (-0.35, [0.14, 0.56], p=0.001, I ² = 70%). (3) Although Tai Chi exercise did no significantly improve the large muscle group of knee joint extensor like quadriceps femoris (3.15, [-0.69, 6.99], p=0.24, I ² = 26%), it showed marked enhancement to the strength of deep small muscle group of knee joint flexor (10.25, [6.90, 13.61], p < 0.00001, I ² = 0%). The heterogeneity might be caused by distinguished measurements of muscle strength. Therefore, Tai Chi exercise specifically enhanced some certain muscle strength of knee joints and improved muscle fitness rehabilitation as well as function activity for elderly.

CONCLUSIONS

In this RCT meta-analysis, Tai Chi exercise has positive effects on lower body strength of elderly. Although no obvious improvement on the knee extensor is observed, it may be used as a rehabilitation treatment for training stable deep muscle groups to improve the knee flexion strength significantly.

The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Exercise intervention has a positive effect on reducing the fall risk in older adults. To investigate the effect of different factors of exercise intervention (type, duration, and frequency) on reducing the fall risk in older adults, a meta-analysis was performed in this study. According to the PRISMA^®, two researchers independently searched PubMed, Web of Science, and the China National Knowledge Infrastructure databases to assess the quality of the studies using the PEDro scale. A total of 648 subjects in 10 randomized controlled trials were included in this study, and the exercise interventions included integrated training (resistance training, core training, and balance training), balance training, core training, Pilates, Ba Duan Jin, and Tai Chi. These studies show that exercise intervention has a huge and significant impact on reducing the risk of falls of the elderly. In conclusion, an integrated intervention with a frequency of more than five times a week and a duration of more than 32 weeks are more effective in reducing the fall risk.

Effects of multicomponent exercise training intervention on hemodynamic and physical function in older residents of long-term care facilities: A multicenter randomized clinical controlled trial

OBJECTIVES

To assess hemodynamic and physical function responses during a two-month multicomponent group exercise program (MCEP) in residents of long-term care facilities.

METHODS

40 older long-term care residents were randomly allocated equally to an intervention (IG; n = 20; 80 ± 7 years) and control group (CG; n = 20; 79 ± 7 years); they all submitted to hemodynamic (blood pressure and heart rate) and functional assessments before and after the MCEP. The IG performed a twice-weekly, two-months multicomponent exercise program composed of functional mobility, balance, muscle strength, and flexibility exercises; while the CG did not perform any exercise intervention.

RESULTS

There was a statistically significant decrease in systolic blood pressure (7.25 ± 14.64 mmHg; t = 2.2; effect size = 0.34; p < 0.05) following a two-month MCEP as compared with baseline. In all functional measurements (balance, mobility) were significantly improved after the MCEP (p < 0.05).

DISCUSSION

These data indicate that a two-month MCEP can improve systolic blood pressure and functionality in older residents of long-term care facilities.

Assessment of the efficacy and safety of a Judo exercise program in improving the quality of life among elderly patients

Objectives: Several reports have shown that Tai Chi Chuan can be an effective way to prevent falls among the elderly. However, an exercise program that can prevent injury during falls has not been reported previously. The judo technique called ukemi is used to prevent injuries. To evaluate whether a judo-based exercise program could prevent falls in the elderly, we had the participants practice ukemi as part of a therapeutic routine. The purpose of this study was to examine the clinical significance of the program and to predict its safety. Methods: From July 2016 to March 2017, we examined 53 individuals who participated in the exercise program. The individuals were divided into high (n=39) and low (n=14) movement ability groups (HMA and LMA groups, respectively), and their physical and psychological functions were evaluated using scores from the Short-Form Health Survey 36. We also collected and analyzed data from questionnaires obtained from 384 patients who participated in the program from July 2016 to July 2019. Results: The HMA group showed a significant increase in the mental component summary scores before and after the exercise program. In the LMA group, physical functioning, social functioning, and physical component summary scores were significantly improved. Of the participants surveyed, 94.8% had a high level of satisfaction, and 93.2% began accepting the exercise as a daily habit. No adverse events were observed during these exercises. Conclusion: This novel exercise program was performed safely, and positive effects were observed, especially in individuals with a low quality of life.

Falls prevention interventions for community-dwelling older people living in mainland China: a narrative systematic review

Background

Falls in community-dwelling older people have been recognised as a significant public health issue in China given the rapidly growing aged population. Although there are several reviews documenting falls prevention programs for community-dwelling older adults, no systematic reviews of the scope and quality of falls prevention interventions in Mainland China exist. Therefore, the aim of this study was to systematically review falls prevention interventions for community-dwelling older people living in Mainland China.

Methods

We systematically reviewed literature from Chinese and English databases. All types of randomised controlled trials (RCTs) and quasi-experimental studies published from 1st January 1990 to 30th September 2019 were included. Observational studies and studies in care facilities and hospitals were excluded. Narrative synthesis was performed to summarise the key features of all included studies. Quality assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I tool for randomised and non-randomised studies respectively.

Results

A total of 1020 studies were found, and 101 studies were included in the analysis. Overall, very few high quality studies were identified, and there was insufficient rigor to generate reliable evidence on the effectiveness of interventions or their scalability. Most interventions were multiple component interventions, and most studies focused on outcomes such as self-reported falls incidence or awareness of falls prevention.

Conclusion

There is an opportunity to undertake an evaluation of a rigorously-designed, large-scale falls prevention program for community-dwelling older people in Mainland China. To help mitigate the rising burden of falls in Mainland China, recommendations for future falls prevention interventions have been made. These include: (1) target disadvantaged populations; (2) incorporate personalised interventions; and (3) investigate the effectiveness of those under-explored interventions, such as psychological, social environment, management of urinary incontinence, fluid or nutrition therapy and surgery. The study results will also potentially provide a useful evidence base for other low-and-middle income countries in a similar situation.

The effects of tai chi chuan exercise training on countermovement jump performance in the elderly

This study sought to compare the biomechanical parameters of the lower extremities during a countermovement jump in elderly people who are engaged in frequent practice of tai chi chuan (TCG) and in the general population of healthy elderly people (HG). Each group included 12 participants. Ten Vicon Motion System infrared cameras and two Kistler force plates were employed for measurement. The jump height, duration, centre of mass (COM) displacement, joint ROM, and upward velocity were analysed in this study. Motion analysis and force platform data were combined to calculate joint moments and powers during the takeoff phase. The data were analysed using independent sample t-tests. The results showed that the tai chi chuan practitioner group (0.13 m) achieved 44% higher jump heights (p < 0.05). The COM displacement during squatting was lower in the TCG (0.25 m) than in the HG (0.19 m) (p < 0.05). The knee and ankle ROMs of the TCG were higher than those of the HG (p < 0.05). Peak knee moment 23% and peak knee power 32% higher in TCG compared to the HG (p < 0.05), suggesting that frequent practice of tai chi chuan may slow the rate of knee degeneration.

Influence of strength training and multicomponent training on the functionality of older adults: systematic review and meta-analysis

Abstract Physical exercise is an important option to maintain functional independence in older adults, however, it is not clear which type of exercise is the most benefic: strength or multicomponent. The objective was to verify the effectiveness of strength training and multicomponent training on functionality of healthy older patients through a systematic review with meta-analysis. Registration number: CRD42017071887. Two independent evaluators searched Pubmed, Web of Science, PEDro, Cochrane and Lilacs databases. Of the 1434 studies found, 32 clinical trials that investigated the effects of strength training only and/or combined with other modalities (multicomponent) in older adults and evaluated the Timed up and Go (TUG), sit-to-stand (STS) and/or Berg Balance Scale (BBS were included. The methodological quality was evaluated with the Downs & Black scale. Data analysis was performed with the Software Review Manager. It was verified improvement in all the investigated outcomes when performing multicomponent training in comparison to control groups. Strength training, compared to control groups, showed benefit only for sit to stand test. Studies comparing the two trainings found no difference between them. The not high average score in the methodological quality assessment of the included studies is a limitation of the present study. In conclusion, both types of training were effective to improve functionality and are good strategies of training for older individuals. However, as the comparison between the two types of training was performed in few studies, it is not possible to infer which is more effective for the functionality, suggesting the realization of new clinical trials.

Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial

Type 2 diabetes mellitus (T2DM) is significantly associated with osteoarthritis (OA). This study investigated the effects of two resistance exercise approaches on glycated hemoglobin (HbA1c) level and function performance. Enrolled were 70 older patients with both T2DM and knee OA. The dynamic group performed resistance exercises with an elastic resistance band. The isometric group underwent isometric contraction exercises. After the 12-week intervention, a significant within-group improvement (all p < 0.001) was observed for the chair stand test (CST; 10.8%, vs. 7.1%), timed up and go (TUG) test (12.6% vs. 7.6%), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function subscale (62.3% vs. 36.1%), and overall WOMAC (54.5% vs. 34.5%) in the dynamic and isometric group, respectively. In addition, in terms of between-group differences, the dynamic group had significant improvements in CST (p = 0.011), TUG (p < 0.001), WOMAC physical function subscale (p = 0.033), and overall WOMAC (p = 0.036) scores compared with the isometric group. However, no significant change in HbA1c was observed in either group. In conclusion, the dynamic resistance exercise significantly improved muscle strength, dynamic balance, and physical function in this comorbid population; however, there was no notable difference in change in HbA1c among different resistance exercises.

A turn for the worse: Turning performance in Parkinson's disease and Essential tremor

BACKGROUND

Turning is an activity of daily living known to elicit falls in older adults and particularly in persons with movement disorders. Specifically, those with Parkinson's disease have marked impairments in forward walking and turning. Although recent work has identified gait impairment in those with Essential tremor, turning has not been extensively evaluated. As the cerebellum is key in the pathophysiology of Essential tremor, complex tasks like turning, may be impaired for this population. The purpose of this study was to investigate turning behavior and falls in those with Essential tremor and Parkinson's disease.

METHODS

15 persons with Essential tremor and 15 persons with Parkinson's disease performed forward walking and turns on an instrumented walkway. t-tests compared groups and a regression was performed to predict fall frequency.

FINDINGS

During turning, those with Essential tremor had lower cadence (p = .042) and took more time (p = .05). No other variables, including forward walking variables, differed between groups. When pooling groups, the significant fall frequency predictor model (p = .003) included decreased forward cadence, increased turning cadence, and female sex. Overall, the model explained 40.7% of the variance.

INTERPRETATION

While forward gait performance was similar between groups, those with Essential tremor had increased turn time, a measure often associated with turning impairment. Together, these results suggest overall gait impairment in Essential tremor is more prevalent than recognized. Walking performance, both turning and forward, and sex were predictive of fall frequency. Therapeutic interventions in these populations should include both forward walking and turns to mitigate fall risk.

Effects of Tai Chi on Cerebral Hemodynamics and Health-Related Outcomes in Older Community Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial

This study investigated the effects of Tai Chi compared with no exercise control on the cerebral hemodynamic parameters and other health-related factors in community older adults at risk of ischemic stroke. A total of 170 eligible participants were randomly allocated to Tai Chi or control group. The cerebral hemodynamic parameters and physical fitness risk factors of cardiovascular disease were measured at baseline, 12 weeks, and 24 weeks. After the 12-week intervention, Tai Chi significantly improved the minimum of blood flow velocity (BFVmin); BFVmean; pulsatility index and resistance index of the right anterior cerebral artery; and BFVmax, BFVmin, and BFVmeanparameters of the right middle cerebral artery. Tai Chi training also decreased triglyceride, fasting blood glucose, and homocysteine levels, and improved balance ability. Therefore, the supervised 12-week Tai Chi exercise had potential beneficial effects on cerebral hemodynamics, plasma risk factors, and balance ability in older community adults at risk of ischemic stroke.

Successful Negotiation of Anticipated and Unanticipated Obstacles in Young and Older Adults: Not All Is as Expected

BACKGROUND

Tripping over an obstacle is one of the most common causes of falls among older adults; however, the impact of obstacle parameters and subject characteristics are not well described.

OBJECTIVES

To evaluate age-associated changes in the ability to negotiate obstacles and the role of obstacle parameters (e.g., anticipated vs. unanticipated, height, and available response time [ART]), and subject characteristics.

METHODS

Twenty healthy older adults (77.7 ± 3.4 years; 50% women) and 20 healthy young adults (29.3 ± 3.8 years; 50% women) underwent cognitive, gait, and balance testing before negotiating a computer-controlled obstacle course. The primary outcome measure was the ability to successfully negotiate the obstacles (without touching them).

RESULTS

The success rate for all subjects was higher when the obstacle was anticipated (99.0 ± 2.8%) than when unanticipated (66.0 ± 20.2%; p < 0.001). The obstacle height had a significant effect on the success rate (p = 0.022); the success rate was lower when the obstacle height was lower. No significant interaction between group and obstacle height was observed (p = 0.096). ART had no significant effect on the success rate (p = 0.294) in both of the groups (ART × group, p = 0.136). However, a significant interaction between group, obstacle height, and ART was found (p = 0.013), reflecting a lower success rate in the older adults when the obstacles were low and unanticipated. In general, older adults demonstrated a trend towards a lower success rate in all types of obstacles compared to the young adults (p = 0.057). Among the older adults, the success rate in the anticipated obstacle condition was correlated with stride length (ρ = 0.600, p = 0.005), step time coefficient of variation (ρ = -0.635, p = 0.003), and gait speed (rho = 0.530, p = 0.016). Montreal Cognitive Assessment scores tended to be related to the difference in the success rate between the anticipated and unanticipated conditions.

CONCLUSIONS

These findings support the idea that motor and, to some degree, cognitive functions are needed to successfully negotiate obstacles, and provide new insights into the ability of older adults to successfully negotiate obstacles. Furthermore, the present results suggest that when it comes to the physical properties of obstacles, not all is as expected, and low obstacles may impose a greater danger to tripping than obstacles that have a higher height.

Identification of Knee Osteoarthritis Based on Bayesian Network: Pilot Study

Background

Early identification of knee osteoarthritis (OA) can improve treatment outcomes and reduce medical costs. However, there are major limitations among existing classification or prediction models, including abstract data processing and complicated dataset attributes, which hinder their applications in clinical practice.

Objective

The aim of this study was to propose a Bayesian network (BN)–based classification model to classify people with knee OA. The proposed model can be treated as a prescreening tool, which can provide decision support for health professionals.

Methods

The proposed model’s structure was based on a 3-level BN structure and then retrained by the Bayesian Search (BS) learning algorithm. The model’s parameters were determined by the expectation-maximization algorithm. The used dataset included backgrounds, the target disease, and predictors. The performance of the model was evaluated based on classification accuracy, area under the curve (AUC), specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV); it was also compared with other well-known classification models. A test was also performed to explore whether physical fitness tests could improve the performance of the proposed model.

Results

A total of 249 elderly people between the ages of 60 and 80 years, living in the Kongjiang community (Shanghai), were recruited from April to September 2007. A total of 157 instances were adopted as the dataset after data preprocessing. The experimental results showed that the results of the proposed model were higher than, or equal to, the mean scores of other classification models: .754 for accuracy, .78 for AUC, .78 for specificity, and .73 for sensitivity. The proposed model provided .45 for PPV and .92 for NPV at the prevalence of 20%. The proposed model also showed a significant improvement when compared with the traditional BN model: 6.3% increase in accuracy (from .709 to .754), 4.0% increase in AUC (from .75 to .78), 6.8% increase in specificity (from .73 to .78), 5.8% increase in sensitivity (from .69 to .73), 15.4% increase in PPV (from .39 to .45), and 2.2% increase in NPV (from .90 to .92). Furthermore, the test results showed that the performance of the proposed model could be largely enhanced through physical fitness tests in 3 evaluation indices: 10.6% increase in accuracy (from .682 to .754), 16.4% increase in AUC (from .67 to .78), and 30.0% increase in specificity (from .60 to .78).

Conclusions

The proposed model presents a promising method to classify people with knee OA when compared with other classification models and the traditional BN model. It could be implemented in clinical practice as a prescreening tool for knee OA, which would not only improve the quality of health care for elderly people but also reduce overall medical costs.

Circuit Training Improvements in Korean Women with Sarcopenia

Sarcopenia is defined as an age-related decrease in muscle mass, strength, and function. We investigated the effect of circuit training on body composition, balance, muscle mass and strength, and pulmonary function in Korean women with sarcopenia. We randomly assigned 26 Korean women with sarcopenia (M_age = 74.9, SD = 4.5 years) to either an exercise group (EG) (n = 13) or a control group (CG) (n = 13). The EG performed 25-75 minutes of circuit exercise training (gradually increasing time periods) three times per week over 12 weeks, while the CG maintained their usual daily lifestyle during the intervention period. We measured body weight, body mass index, percent body fat, free fat mass, balance ability, peak torque in shoulder, knee, and lumbar joints normalized for bodyweight (BW), forced vital capacity, percentage of forced expiratory volume in one second, and forced expiratory flow 25-75% before and after the intervention. The EG showed improved body composition (i.e., body mass index, fat-free body mass, fat mass; all p < .032, η²> 0.180), balance (i.e., right and left of static and dynamic balance and fast 10-m walk; all p < .050, η²> 0.151), muscular function (i.e., 90°/s and 180°/s peak power per kilogram BW, 90°/s average power per kilogram BW, 180°/s total work, and 180°/s endurance ratio; all p < .045, η²> 0.157), and pulmonary function (all p < .005, η²> 0.292). On the other hand, the CG showed no significant changes. Circuit exercise training improves muscle mass and strength, body composition, balance, and pulmonary function in women with sarcopenia.

Effects of Kinect-based exergaming on frailty status and physical performance in prefrail and frail elderly: A randomized controlled trial

Frailty status can be improved by intervention. Both exergaming and combined exercise have been proposed for improving physical performance in community-dwelling elderly. However, whether frailty status can be improved by exergaming is unclear. Moreover, whether Kinect-based exergaming training can exert a stronger effect on improving frailty status than combined exercise needs to be established. The aim of this study was to investigate the effects of Kinect-based exergaming on improving frailty status and physical performance in the prefrail and frail elderly by comparing its effects with those of combined exercise. Fifty-two prefrail and frail elderly were recruited and randomized to the Kinect-based exergaming group (EXER group) or combined exercise group (CE group), emphasizing resistance, aerobic, and balance training for 36 sessions over 12 weeks. Our results showed that both groups improved the frailty status (EXER group: p = 0.016, effect size = 2.29; and CE group: p = 0.031, effect size = 2.67). Three out of 5 physical characteristics of the frailty phenotype, namely, weakness, slow walking speed, and low activity level, were significantly reversed by both exergaming and combined exercise. However, the exergaming training also significantly reversed exhaustion. Furthermore, compared with the CE group, the EXER group showed greater improvement in dynamic balance control, as indicated by the forward reaching test (p = 0.0013, effect size = 0.40) and single leg stance test (p = 0.049, effect size = 0.42). Thus, Kinect-based exergaming exerted effects that were at least as beneficial as those of combined exercise in improving frailty status and the frailty phenotype. We recommend the use of exergaming aided by Kinect in the prefrail and frail elderly.

Effects of Tai Chi on partial anterior cruciate ligament injury: A single-blind, randomized-controlled trial

Objectives

This study aims to investigate the effects of Tai Chi (TC) exercises on muscle strength, pain, proprioception, and knee function in patients with partial anterior cruciate ligament (ACL) injuries.

Patients and methods

Between March 2017 and January 2018, a total of 58 patients with partial ACL injuries (30 male, 28 female; mean age 25.5±6.4; range, 18 to 36 years) were included in the study. The patients were randomly divided into two groups: TC group (n=29) and control group (n=29). For both groups, an activity modification approach was applied. The TC group participated in a 24-week TC exercise program, while no exercise or home-based program was administered to the control group. Isokinetic knee extension and flexion muscle strengths were evaluated at angular velocities of 60°/sec and 180°/sec. The visual analog scale (VAS), isokinetic system, Lysholm Knee Scale (LKS), and International Knee Documentation Committee 2000 (IKDC-2000) were used for the evaluation of pain, proprioception, and knee function, respectively.

Results

Significant changes were found in the TC group for the knee extensor muscle strength measured at an angular velocity of 60°/sec (p=0.012) and 180°/sec (p=0.011), VAS pain (p=0.005), and proprioception (measured with isokinetic device) (p<0.001). While knee extensor muscle strength, pain, proprioception, LKS, and IKDC-2000 scores improved in the TC group, improvements were recorded only for LKS and IKDC-2000 scores in the control group.

Conclusion

Based on these results, we conclude that TC exercises can yield positive outcomes on the knee extensor muscle strength, pain, proprioception and knee function in patients with partial ACL injuries. Hence, TC exercises can be used as a novel method by researchers and clinicians in the treatment of partial ACL injuries.

Tai Chi Combined With Resistance Training for Adults Aged 50 Years and Older: A Systematic Review

BACKGROUND AND PURPOSE

Despite Tai Chi and resistance training being recommended as suitable exercise for older adults, there are no systematic reviews synthesizing the effectiveness of a combination of Tai Chi and resistance training on health promotion of older adults. This study aimed to review the existing literature regarding the effect of Tai Chi and resistance training on physical health, mental health, pain, health-related quality of life, and age-related impairment in adults aged 50 years and older.

METHODS

A systematic review was conducted to report the health outcomes of Tai Chi combined with resistance training research in adults aged 50 years and older. Articles were identified by searching PubMed, Scopus, Web of Science, CINAHL, MEDLINE, Physiotherapy Evidence Database (PEDro), and the Cochrane library using search terms representing "Tai Chi" and "resistance" and "older adults." Quantitative experimental studies with participants aged 50 years and older, where one of the interventions was Tai Chi and resistance training, were included.

RESULTS AND DISCUSSION

The literature search yielded 648 articles from which 7 met the inclusion criteria. Collectively, the studies involved 703 participants aged 50 years and older, including healthy older adults, older adults with history of falls, postmenopausal women, and people diagnosed with end-stage hip osteoarthritis. Studies included different Tai Chi forms in combination with various types of resistance training. Training sessions were 2 to 7.5 h/wk and lasted between 12 weeks and 12 months. After long-term Tai Chi and resistance training, the participants showed significant improvement in upper and lower extremity muscle strength, aerobic endurance, balance, and mobility. However, 1 study failed to show improvement in Functional Movement Screening compared with traditional Tai Chi and nonexercise groups. No study examined the effects of Tai Chi and resistance training on health-related quality of life, fear of falling, or mental health in adults aged 50 years and older.

CONCLUSIONS

The review supports that Tai Chi in combination with resistance training improves physical function and muscle strength in adults aged 50 years and older.

Relationship between a three-month physical conditioning "posture-balance-motricity and health education" (PBM-HE) program on postural and balance capacities of sedentary older adults: influence of initial motor profile

Background

The aims of this study were (i) to define the relationship between a physical reconditioning cycle using balance exercises and muscular-articular stress and the balance capabilities of sedentary older adults and (ii) to assess whether older adults with weaker equilibrium abilities have a significantly limited progression. Our sample consisted of 338 people (263 women, 75 men) with an age, weight and height of 74.4 years (+/− 8.6), 67 kg (+/− 13.6) and 161.4 cm (+/− 8) and with a body mass index of 25.6 (+/− 4.3). The functional evaluations consisted of individual motor profile tests, monopodal eyes open and eyes closed for 30 s, a Timed Up and Go test (TUG) and stabilometric measurements on hard ground with eyes open for a duration of 25.6 s. The physical repackaging protocol was based on the 12-week Posture-Balance-Motricity and Health Education (PBM-ES) method with two 90-min weekly group sessions.

Results

The evolution of the “posture” and “balance” variables was significantly associated with the equilibration capacities (p < 0.001). For unipedal stance with open eyes on the dominant and non-dominant sides, respectively, the progressions were significant for the profiles of middle (OR: 4.78 and 2.42) and low levels (OR: 4.34 and 1.66). Eyes-closed progressions were non-significant for the low-level balance profiles. For the COP Surface and Length variables, compared to those with high levels of balance, respectively, the progressions were significant for the middle- (OR: 1.41 and 2.98) and low-level (OR: 2.91 and 3.28) profiles.

Conclusions

After a 3-month bi-weekly PBM-HE program, we observed that sedentary older adults with the lowest initial level of balance progressed significantly more than high-level individuals, but only for basic motor abilities. It turns out that even among the most deconditioned people and older adults, very significant progress can be made. This increase requires an individualized training content focused on initial mobilizable capacities.

Is Kinect Training Superior to Conventional Balance Training for Healthy Older Adults to Improve Postural Control?

OBJECTIVE

To investigate the effects of balance training to improve postural control in adults older than 60. Our aim was to find out if Kinect training is superior to the conventional balance training in aspects of functional balance tests and posturography measurements testing postural stability through visual feedback.

MATERIALS AND METHODS

Thirty subjects participated in the Kinect training group (29 women and 1 man), practiced Kinect Adventures and Sports, 23 volunteers (22 women and 1 man) attended the conventional balance training, and 22 participants (18 women and 4 men) were allocated to the no-intervention control group. Both interventions lasted for 6 weeks, three times a week, and 30 minutes per session. The Four-Square Step Test, Functional Reach Test, Timed Up and Go test, Timed Up and Go cognitive dual-task test were measured, and for the assessment of the limit of stability (LOS), we used computerized posturography. Measurements were taken before the training at baseline and 6 weeks after (follow-up) the interventions. Statistical analysis was done through two-factor mixed analysis of variance and Newman-Keuls post hoc test.

RESULTS

Both training groups showed progress in the follow-up measurements; however, more statistically significant improvements were found in favor of the Kinect balance training group (Timed Up and Go test [P < 0.05], Timed Up and Go cognitive dual-task test [P < 0.05], Four-Square Step Test [P < 0.05], Functional Reach Test [P < 0.05], LOS movement velocity [P < 0.05]).

CONCLUSION

Our results suggest that Kinect balance training may be a preferable and safe method for the healthy older adults to improve postural control and reduce the possibility of falling.

Influence of a brisk walking program on postural responses in sedentary older women: a randomised trial

This study analyzes the evolution in kinematic and non-linear stabilometric parameters in elderly sedentary women selected to participate in a brisk walking program. Ninety-four women were randomly selected for a program of 78 sessions over 6 months, with three sessions of 60 min per week. On the force platform, participants were assessed with both eyes opened as well as eyes closed during a period of 51.2 s and the sampling frequency was 40 Hz. The main dependent kinematic variables were the length, stabilogram surface, and the mean position in anteroposterior as well as medio-lateral directions. For the dynamic approach, we have selected the parameters of recurrence quantification analysis, sample entropy, and multiscale entropy. The kinematic and the time series analysis of group × time interactions demonstrated that 6 months of walk-training lacked influence on kinematic postural responses and on dynamical measurements. The weekly brisk walking program was situated on flat ground and consisted of three 60-min weekly sessions lasting 6 months, leading to no significant effect on postural responses. In regards to international recommendations brisk walking is a pertinent exercise. However, in older sedentary women, our study indicated a systemic lack of influence of 6 months' walk-training on flat ground on kinematic postural responses and on dynamical measures obtained by time series analysis.

Multiple-modality exercise and mind-motor training to improve mobility in older adults: A randomized controlled trial

OBJECTIVE

To investigate the effects of multiple-modality exercise with or without additional mind-motor training on mobility outcomes in older adults with subjective cognitive complaints.

METHODS

This was a 24-week randomized controlled trial with a 28-week no-contact follow-up. Community-dwelling older adults underwent a thrice -weekly, Multiple-Modality exercise and Mind-Motor (M4) training or Multiple-Modality (M2) exercise with an active control intervention (balance, range of motion and breathing exercises). Study outcomes included differences between groups at 24weeks and after the no-contact follow-up (i.e., 52weeks) in usual and dual-task (DT, i.e., serial sevens [S7] and phonemic verbal fluency [VF] tasks) gait velocity, step length and cycle time variability, as well as DT cognitive accuracy.

RESULTS

127 participants (mean age 67.5 [7.3] years, 71% women) were randomized to either M2 (n=64) or M4 (n=63) groups. Participants were assessed at baseline, intervention endpoint (24weeks), and study endpoint (52weeks). At 24weeks, the M2 group demonstrated greater improvements in usual gait velocity, usual step length, and DT gait velocity (VF) compared to the M4 group, and no between- or within-group changes in DT accuracy were observed. At 52weeks, the M2 group retained the gains in gait velocity and step length, whereas the M4 group demonstrated trends for improvement (p=0.052) in DT cognitive accuracy (VF).

CONCLUSIONS

Our results suggest that additional mind-motor training was not effective to improve mobility outcomes. In fact, participants in the active control group experienced greater benefits as a result of the intervention.

Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults: A Randomized Clinical Trial

IMPORTANCE

Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults.

OBJECTIVE

To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults.

DESIGN, SETTING, AND PARTICIPANTS

Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable.

INTERVENTIONS

Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises.

MAIN OUTCOMES AND MEASURES

The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals.

RESULTS

Participants (mean [SD] age, 80.0 [8.1] years) were mostly female (251 [84.2%]) and white (249 [83.6%]) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 [0.13] vs -0.01 [0.11] m/s; adjusted difference = 0.05 [0.02] m/s; P = .002) and 6-minute walk distance (20.6 [57.1] vs 4.1 [55.6] m; adjusted difference = 16.7 [7.4] m; P = .03). Attendance was greater in the usual-care program compared with On the Move (95 [65.1%] vs 76 [50.0%] attended ≥20 classes; P = .03). There were no significant differences in any of the other primary or secondary outcomes.

CONCLUSIONS AND RELEVANCE

The On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01986647.

Effects of a physical activity and nutrition program in retirement villages: a cluster randomised controlled trial

Background

This cluster randomised controlled trial aimed to determine if a 6- month home-based intervention could improve the physical activity and dietary behaviours of adults aged 60 to 80 years living in retirement villages located in Perth, Western Australia.

Methods

Participants (n = 363) from 38 retirement villages were recruited into the trial and allocated to the intervention (n = 197: 17 sites) or control (n = 166: 21 sites) group and were blinded. Previously validated instruments-Fat and Fibre Barometer and International Physical Activity Questionnaire, along with anthropometric measures (weight, height, waist and hip circumferences) and blood pressure were collected at baseline and 6 -month time period. Comparisons between intervention and control groups were undertaken pre- and post- intervention using univariate chi-square and t-tests. Multi-level mixed regression analyses were then conducted to ascertain the effects of the intervention on changes in the outcome variables over time and between groups.

Results

A total of 139 (70.5%) intervention and 141 (84.9%) control group participants completed the program and post-test assessments. The intervention group demonstrated significant increases in time (80 min more per week on average) devoted to moderate-intensity physical activity, engagement in strength exercises (from 23.7% to 48.2%), frequency of fruit consumed as well as fat avoidance and fibre intake scores, in addition to a 0.5 kg mean reduction in weight post program, whereas no apparent changes were observed in the control group. Mixed regression results further confirmed statistically significant improvements in weight loss (p < 0.05), engagement in strength exercises (p < 0.001) and fruit intake (p = 0.012) by the intervention participants at post-test relative to their controls.

Conclusions

Retirement offers a time to reassess lifestyle, and adopt positive health enhancing physical activity and dietary behaviours. This intervention was successful in improving weight, engagement in strength exercises, increasing levels of moderate-intensity physical activity and consumption of fruit among retirement village residents. Further investigation is needed on how to better engage retirement village managers in such programs.

Trial registration

Australia and New Zealand Clinical Trial Registry (ACTRN12612001168842) registered November 2, 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0543-6) contains supplementary material, which is available to authorized users.

Effect of Physical Activity versus Health Education on Physical Function, Grip Strength and Mobility

BACKGROUND

Physical activity (PA) reduces the rate of mobility disability, compared with health education (HE), in at risk older adults. It is important to understand aspects of performance contributing to this benefit.

OBJECTIVE

To evaluate intervention effects on tertiary physical performance outcomes.

DESIGN

The Lifestyle Interventions and Independence for Elders (LIFE) was a multi-centered, single-blind randomized trial of older adults.

SETTING

Eight field centers throughout the United States.

PARTICIPANTS

1635 adults aged 78.9 ± 5.2 years, 67.2% women at risk for mobility disability (Short Physical Performance Battery [SPPB] <10).

INTERVENTIONS

Moderate PA including walking, resistance and balance training compared with HE consisting of topics relevant to older adults.

OUTCOMES

Grip strength, SPPB score and its components (balance, 4 m gait speed, and chair-stands), as well as 400 m walking speed.

RESULTS

Total SPPB score was higher in PA versus HE across all follow-up times (overall P = .04) as was the chair-stand component (overall P < .001). No intervention effects were observed for balance (overall P = .12), 4 m gait speed (overall P = .78), or grip strength (overall P = .62). However, 400 m walking speed was faster in PA versus HE group (overall P =<.001). In separate models, 29% of the rate reduction of major mobility disability in the PA versus HE group was explained by change in SPPB score, while 39% was explained by change in the chair stand component.

CONCLUSION

Lower extremity performance (SPPB) was significantly higher in the PA compared with HE group. Changes in chair-stand score explained a considerable portion of the effect of PA on the reduction of major mobility disability-consistent with the idea that preserving muscle strength/power may be important for the prevention of major mobility disability.

Influence of a brisk walking program on isokinetic muscular capacities of knee in sedentary older women

This study analyzed the evolution in peak torque (PT) and mean power (MP) isokinetic parameters in the quadriceps and hamstring muscles of elderly sedentary women who were randomly selected to participate in a brisk walking program for 6 months. The 121 sedentary women of this study presented a mean score of 5.3 (±1.7) on the Physical Activity Questionnaire for the Elderly and covered 86 % of the theoretical distance on the 6-min walk test. The isokinetic evaluation was performed on both sides at 60°/s and 180°/s. PT and MP were selected for analysis. Women in the trained group (n = 61) participated in a program of 78 sessions over 6 months with three sets of 60 min of exercise per week. For this group, heart rate, time and distance were, respectively, 125.2 bt/min (±10), 37.9 min (±4.2) and 3756.3 m (±445.4). The analysis of the group × time interaction demonstrated an increase in the PT of the dominant-side hamstrings (p < 0.001). In the trained group, we observed a significant increase in PT at 60°/s for the hamstrings on both sides (0.01 < p < 0.02) and a significant increase in MP for the hamstrings at 60°/s on the nondominant side (p < 0.05). The study indicates a minor, though significant, influence of a brisk walking program on the peak torque and mean power of the quadriceps and hamstring muscles in sedentary women over 60 years.

Physical activity and health in the presence of China's economic growth: Meeting the public health challenges of the aging population

Three decades of rapid economic development in China have not only benefited millions of Chinese by improving their living standards but have also dramatically increased the number of people who are part of the country's aging population. However, economic growth has not been accompanied by sufficient attention given to important public health issues, including an increase in the incidence of chronic diseases and a decline in physical activity (PA) that comes with an aging population. The rapid growth in China's older population will soon exert an impact on the nation's economy, population health status, and health behaviors, and will increase stress on its healthcare system. This review article provides a broad perspective on the impact of rapid economic development, industrialization, and urbanization on health-related behaviors, with a specific focus on PA among older adults. Specifically, the article offers an overview of the demographic context, significant public health challenges, evidence on PA and exercise interventions, and knowledge gaps and future directions for research.

Evaluating the fall risk among elderly population by choice step reaction test

Falls during daily activities are often associated with injuries and physical disabilities, thereby affecting quality of life among elder adults. Balance control, which is crucial in avoiding falls, is composed of two elements: muscle strength and central nervous system (CNS) control. A number of studies have reported that reduced muscle strength raises the risk of falling. However, to date there has been only limited research focused on the relationship between fall risk and the CNS. This study aimed to investigate the relationship between CNS and risk of falling among the elderly. A total of 140 elderly people (92 females and 48 males) were divided into faller and nonfaller groups based on questionnaire responses concerning falls in their daily life. Participants undertook a choice step reaction test in which they were required to respond to random visual stimuli using foot movements as fast as possible in the left or right directions. Response time was quantified as premotor time (PMT) and motor time (MT). In addition, the participants’ electro-myography data were recorded during the choice step reaction test. A maximal isokinetic torque test was also performed. PMT was greater in the fallers than in the nonfallers group. There was a significant difference between fall status and direction on PMT. PMT of the left limb in nonfallers was faster than the right, but in fallers there was no difference between left and right limbs. A similar phenomenon was also observed for MT. There were significant differences between fallers and nonfallers in maximum isokinetic torque at knee and ankle joints. The correct rate of PMT was higher than other variables, such as MT and maximal isokinetic torque, in evaluating elderly fall risk by using logistic regression analyses. The results suggest that PMT in the choice step reaction test could be a useful parameter to assess risk of fall among elder adults. In addition, decreased maximal isokinetic torque was related to greater PMT and disappearance of asymmetry in older adults who were at higher risk of fall, especially in the lower limb.

Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial

BACKGROUND

Losses in lower extremity muscle strength/power, muscle mass and deficits in static and particularly dynamic balance due to aging are associated with impaired functional performance and an increased fall risk. It has been shown that the combination of balance and strength training (BST) mitigates these age-related deficits. However, it is unresolved whether supervised versus unsupervised BST is equally effective in improving muscle power and balance in older adults.

OBJECTIVE

This study examined the impact of a 12-week BST program followed by 12 weeks of detraining on measures of balance and muscle power in healthy older adults enrolled in supervised (SUP) or unsupervised (UNSUP) training.

METHODS

Sixty-six older adults (men: 25, women: 41; age 73 ± 4 years) were randomly assigned to a SUP group (2/week supervised training, 1/week unsupervised training; n = 22), an UNSUP group (3/week unsupervised training; n = 22) or a passive control group (CON; n = 22). Static (i.e., Romberg Test) and dynamic (i.e., 10-meter walk test) steady-state, proactive (i.e., Timed Up and Go Test, Functional Reach Test), and reactive balance (e.g., Push and Release Test), as well as lower extremity muscle power (i.e., Chair Stand Test; Stair Ascent and Descent Test) were tested before and after the active training phase as well as after detraining.

RESULTS

Adherence rates to training were 92% for SUP and 97% for UNSUP. BST resulted in significant group × time interactions. Post hoc analyses showed, among others, significant training-related improvements for the Romberg Test, stride velocity, Timed Up and Go Test, and Chair Stand Test in favor of the SUP group. Following detraining, significantly enhanced performances (compared to baseline) were still present in 13 variables for the SUP group and in 10 variables for the UNSUP group.

CONCLUSION

Twelve weeks of BST proved to be safe (no training-related injuries) and feasible (high attendance rates of >90%). Deficits of balance and lower extremity muscle power can be mitigated by BST in healthy older adults. Additionally, supervised as compared to unsupervised BST was more effective. Thus, it is recommended to counteract intrinsic fall risk factors by applying supervised BST programs for older adults.