Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls

Effects of High-Intensity Functional Training (HIFT) on the Functional Capacity, Frailty, and Physical Condition of Older Adults with Mild Cognitive Impairment: A Blind Randomized Controlled Clinical Trial

Physical exercise has been established as an intervention in the integral approach for the physical, functional, and social health of older adults. The objective of this study was to determine the effects of a high-intensity functional training (HIFT) program on the physical condition and functional capacity of an elderly Colombian population with mild cognitive impairment. This research corresponds to a blind randomized controlled clinical trial. A total of 169 men and women aged over 65 years were evaluated and distributed in two groups: the experimental group that received a 12-week HIFT intervention (n = 82) and the control group (n = 87) that received general recommendations on the benefits of physical exercise. The outcome variables included physical condition, assessed using the Senior Fitness battery (SNB); Fried's frailty phenotype was applied, and gait and balance were assessed using the Tinetti scale. For the functional variables, activities of daily living, instrumental activities of daily living, and advanced activities of daily living were evaluated. All variables were measured pre- and post-intervention. Statistically significant improvements were observed in the IG for gait stability and balance (p < 0.001), as well as for independence in activities of daily living (p = 0.003), and instrumental and advanced activities (p < 0.001). Likewise, greater functionality was found when assessed with the SNB (p < 0.001), except for upper limb strength. The frailty classification did not show changes post-intervention (p = 0.170) nor in the group x time interaction. MANCOVA analysis showed that regardless of gender, health level, age, BMI, cognition, and health level, the HIFT intervention produced better results in functional capacity, balance, and gait (F = 0.173, p < 0.001, Wilks' λ = 88.231).

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (β = .52, p < .01) and reduces the time required to complete physical functions (β = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Impact of Different Resistance Training Protocols on Balance, Quality of Life and Physical Activity Level of Older Women

BACKGROUND

Physical activity (PA) and physical fitness are key factors for quality of life (QoL) for older women. The aging process promotes the decrease in some capacities such as strength, which affect the activities of daily life. This loss of strength leads to a reduction in balance and an increased risk of falls as well as a sedentary lifestyle. Resistance Training (RT) is an effective method to improve balance and strength but different RT protocols can promote different responses. Power training has a higher impact on the performance of activities of daily life. Therefore, our study aimed to analyze if different RT protocols promote individual responses in balance, QoL and PA levels of older women and which are more effective for the older women.

METHODS

Ninety-four older women were divided into four RT groups (relative strength endurance training, SET; Traditional strength training, TRT; absolute strength training, AST; power training, PWT) and one control group (CG). Each RT group performed a specific protocol for 16 weeks. At baseline and after 8 and 16 weeks, we assessed balance through the Berg balance scale; PA levels with a modified Baecke questionnaire and QoL with World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Quality of Life-OLD module (WHOQOL-OLD).

RESULTS

Balance improved after 16 weeks (baseline vs. 16 weeks; p < 0.05) without differences between all RT groups. PWT (2.82%) and TRT (3.48%) improved balance in the first 8 weeks (baseline vs. 8 weeks; p < 0.05). PA levels increased in PWT, TRT and AST after 16 weeks (baseline vs. 16 weeks; p < 0.05).

CONCLUSION

All RT protocols improved PA levels and QoL after 16 weeks of training. For the improvement of balance, QoL and PA, older women can be subjected to PWT, AST and SET, and not be restricted to TRT.

Incongruity of Geometric and Spectral Markers in the Assessment of Body Sway

Different measurements of body oscillations in the time or frequency domain are being employed as markers of gait and balance abnormalities. This study investigates basic relationships within and between geometric and spectral measures in a population of young adult subjects. Twenty healthy subjects stood with parallel feet on a force platform with and without a foam pad. Adaptation effects to prolonged stance were assessed by comparing the first and last of a series of eight successive trials. Centre of Foot Pressure (CoP) excursions were recorded with Eyes Closed (EC) and Open (EO) for 90s. Geometric measures (Sway Area, Path Length), standard deviation (SD) of the excursions, and spectral measure (mean power Spectrum Level and Median Frequency), along the medio-lateral (ML) and antero-posterior (AP) direction were computed. Sway Area was more strongly associated than Path Length with CoP SD and, consequently, with mean Spectrum Level for both ML and AP, and both visual and surface conditions. The squared-SD directly specified the mean power Spectrum Level of CoP excursions (ML and AP) in all conditions. Median Frequency was hardly related to Spectrum Level. Adaptation had a confounding effect, whereby equal values of Sway Area, Path Length, and Spectrum Level corresponded to different Median Frequency values. Mean Spectrum Level and SDs of the time series of CoP ML and AP excursions convey the same meaning and bear an acceptable correspondence with Sway Area values. Shifts in Median Frequency values represent important indications of neuromuscular control of stance and of the effects of vision, support conditions, and adaptation. The Romberg Quotient EC/EO for a given variable is contingent on the compliance of the base of support and adaptation, and different between Sway Area and Path Length, but similar between Sway Area and Spectrum Level (AP and ML). These measures must be taken with caution in clinical studies, and considered together in order to get a reliable indication of overall body sway, of modifications by sensory and standing condition, and of changes with ageing, medical conditions and rehabilitation treatment. However, distinct measures shed light on the discrete mechanisms and complex processes underpinning the maintenance of stance.

The efficacy of balance and proprioception exercises in female patients with knee osteoarthritis: A randomized controlled study

OBJECTIVE

Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis.

DESIGN

A single-center randomized trial with three parallel arms.

SETTING

A tertiary health care facility in Turkey.

PARTICIPANTS

Female patients with knee osteoarthritis aged 40-70 years.

INTERVENTIONS

Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups.

MAIN MEASURES

Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score).

RESULTS

Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance - Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor.

CONCLUSIONS

Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.

Increased 18F-FDG Uptake in the Axillary Lymph Nodes of the Vaccinated Side Associated with COVID-19 Vaccination

A 50-year-old female patient underwent (¹⁸fluorine-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) following modified radical mastectomy for cancer of the left breast. Ten days before the PET/CT, the coronavirus disease-2019 (COVID-19) vaccine was injected intramuscularly into the right deltoid muscle. Increased (¹⁸F-FDG uptake of maximum standardized uptake value (11.0) was observed in the lymph nodes of the right axilla, which had not been observed in the previous PET/CT. The size of the oval-shaped lymph nodes was up to approximately 11×9 mm; however, it was larger than that observed on the previous PET/CT. We contemplate that the increased (¹⁸F-FDG uptake was a reactive change in the lymph nodes associated with the COVID-19 vaccine.

Effect of 6 weeks of balance training on different heights of medium-density foam in geriatric population

Background

In older adults, progressive aging leads to a gradual decrease in physical and mental well-being, increasing the risk of fall-associated injuries and ultimately changing the quality of life. This increase in fall accidents is due to the impaired balance in older adults. To prevent such incidents, the incorporation of balance training in the rehabilitation of the geriatric population will help in challenging the vestibular system and activates the mechanoreceptors that lead to enhancing the postural stability on an unstable surface. The foam-based balance training helps to effectively improve balance; however, the height and type of foam used for the treatment and assessment purpose varies, and the suitable height of foam required for balance training is still unexplored. Hence, the study aims to determine the efficacy of various heights of medium-density foam for balance training in community-dwelling older adults.

Methods

Forty older adults ranged between 60 to 75 years were randomly chosen and divided into intervention and control groups. Both the group practiced balance training on a firm surface for 2 weeks and later intervention group received foam-based balance training on either 1″, 2″, and 3″ medium-density foam. The balance and fear of fall were measured using Mini-BesTest Scale (MBS) and Fall Efficacy Scale-I (FES-I) respectively. Furthermore, the MBS and FES-I scores were recorded on the pre-, post-2 weeks, and post-6 weeks of foam-based balance training.

Results

The MBS and FES-I show a statistically significant difference (<0.05) in pre- and post-interventions and control groups. The components of MBS merely show a significant difference in effect size in the intervention group, and it indicates poor clinical relevance in using a specific height of foam for balance training in older adults. However, within group analysis, the 3″-inch medium-density foam shows the medium effect size (>0.5) in all components of MBS as compared to other groups.

Conclusion

The specific height of foam used for foam-based balance training does not effectively differ the clinical decision-making in planning rehabilitation; rather, a long duration of balance training helps to improve balance in older adults.

Interventions to Improve Body Composition, Upper and Lower Extremity Muscle Strength, and Balance Ability of Older Female Adults: An Intervention Study

The aim of the present study was to understand the effects of a moderate-intensity physical activity program on the changes observed in the body composition, upper and lower extremity muscle strength, as well as balance in elderly female adults in order to evaluate sarcopenia. In this study, 30 healthy elderly females were recruited and were randomly assigned to either the control group or the experimental group. The experimental group engaged in a moderate-intensity physical activity program twice a week for 8 weeks. Using a body composition analyzer, the senior fitness test, and handgrip strength and gait speed tests, all participants were tested in pre- and post-tests. The results of the study revealed changes in the overall body composition in the experimental group, with significant decreases in body mass index, body fat percentage, and body fat mass and substantial increases in the basal metabolic rate and skeletal muscle mass, while the upper and lower extremity muscle strength and balance ability also showed significant improvements. The moderate-intensity physical activity program also increased upper limb handgrip strength and lower limb gait speed, showing that the plan was able to effectively evaluate sarcopenia. The study concluded that using upper limb handgrip strength and lower limb walking speed to evaluate sarcopenia are useful diagnostic tools. Moderate-intensity physical activity is effective for improving muscle strength and reducing sarcopenia.

Balance factors affecting the quality of life in patients with knee osteoarthritis

Background

Knee osteoarthritis (OA) affects the quality of life (QOL) and balance control of elderly people; our study explored the balance factors that affected the QOL in patients with knee OA.

Objectives

To determine the balance factors that affected the QOL of patients with knee OA who attended general clinics.

Method

A total of 30 healthy controls and 60 patients with mild-to-moderate bilateral knee OA, all aged 55–75 years, were enrolled in our cross-sectional study. All participants were interviewed; the Medical Outcomes Study 36-Item Short-Form Health Survey was used to assess their QOL in eight dimensions, and the Balance Master System was used to evaluate their balance control according to six parameters. Descriptive statistics were used to reduce the data; an independent t-test determined differences between the two groups, and a multiple regression analysis was undertaken to establish associations between variables from the balance control test and SH36 physical and mental health components. The level of statistical significance was set at 5%.

Results

In the OA group, significant negative correlations were observed between sway velocity and the physical health component (p = 0.003) and between sway velocity and the mental health component (p = 0.006). Thus, sway velocity had a major impact on the QOL of patients with knee OA.

Conclusions

The sway velocity at the centre of gravity in balance control was a crucial factor for determining the QOL of patients with bilateral knee OA.

Clinical implications

Sway velocity is a key factor affecting the QOL and may provide a basis to formulate preventive actions and design treatment goals for patients with knee OA.

Phase-Adapted Rehabilitation for Acute Coronavirus Disease-19 Patients and Patient With Long-term Sequelae of Coronavirus Disease-19

ABSTRACT

Since the beginning of the COVID-19 pandemic in early 2020, many papers have highlighted the need for the rehabilitation of patients with SARS-CoV-2 infection. Most papers refer to the need for respiratory rehabilitation in the acute phase; however, the fact that the infection also affects other organ systems has to be considered in rehabilitation interventions. Long-term symptoms in many cases severely limit activity and participation and alter quality of life, leading to rehabilitation needs. This article proposes a phase-adapted model of linking the acute, postacute, and long-term symptoms of COVID-19 with the well-established matrix of acute, postacute, and long-term rehabilitation services. A review of currently available recommendations for phase-adapted rehabilitation strategies, including the relevance of prehabilitation within this context, is provided.