The risk of being fearful or fearless of falls in older people: an empirical validation

PURPOSE: To investigate the risk of being fearful or fearless of falls in older people. METHODS: Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period. RESULTS: Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group. CONCLUSIONS: The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.     

Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability

[Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.Key words: Nintendo Wii Fit Plus, Functional ankle instability, Strength     

Effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone,and gait of stroke patients

[Purpose] The purpose of this study was to investigate the therapeutic effects of virtual reality-based ankle exercise on the dynamic balance, muscle tone, and gait ability of stroke subjects. [Subjects and Methods] Twenty persons who were in the chronic stroke subjects of this study and they were included and assigned to two groups: experimental (VRAE; Virtual Reality-based Ankle Exercise group) (n=10) and control groups (n=10). The VRAE group performed virtual environment system ankle exercise, and the control group watched a video. Both groups performed their respective interventions for 30 minutes per day, 5 times per week over a 6-week period. To confirm the effects of the intervention, dynamic balance, muscle tone, and spatiotemporal gait were evaluated. [Results] The results showed that the dynamic balance and muscle tone was significantly more improved after the intervention compared to before in the VRAE group (dynamic balance: 5.50±2.57; muscle tone: 0.90±0.39), and the improvements were more significant than those in the control (dynamic balance: 1.22±2.05; muscle tone: 0.10±0.21). Spatiotemporal gait measures were significantly more increased in the paretic limb after the intervention compared to before in the VRAE group and the improvements were more significant than those in the control group. [Conclusion] This study demonstrated that virtual reality-based ankle exercise effectively improves the dynamic balance, muscle tone, and gait ability of stroke patients.Key words: Stroke, Virtual reality-based ankle exercise, Gait     

The risk of being fearful or fearless of falls in older people: An empirical validation

Purpose.?To investigate the risk of being fearful or fearless of falls in older people.

Methods.?Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period.

Results.?Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group.

Conclusions.?The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.     

Is hypertension a risk factor for poor balance control in elderly adults?

[Purpose] The aim of this study was to investigate whether hypertension negatively affects the postural balance control of elderly adults under different sensory conditions. [Subjects and Methods] Fifty-four healthy elderly adults who were residents in a Geriatric Home Care Center were recruited for this study. Height, weight, body mass index and age of the volunteers were recorded. After applying the exclusion criteria, the final study group included 16 hypertensive (HT) and the control group included 10 non-hypertensive (Non-HT) healthy elderly adults. To evaluate postural balance control objectively, the modified Clinical Test of Sensory Interaction on Balance (modified CTSIB) test was performed under four different conditions: 1) eyes open on a stable surface; 2) eyes closed on a stable surface; 3) eyes open on an unstable surface; and 4) eyes closed on an unstable surface. [Results] The postural balance scores (center of gravity sway) of the HT group were slightly higher than those of the Non-HT group under conditions 1 (HT group=0.3°/sec, Non-HT group=0.2°/sec), 2 (HT group=0.8°/sec, Non-HT group=0.4°/sec) and 4 (HT group=4.5°/sec, Non-HT group=3.5°/sec), but no statistically significant differences were found between the HT and Non-HT groups under any sensory condition. [Conclusion] The result of this study indicate that controlled hypertension in elderly adults is not a cause of worse balance performance than controls on stable or unstable surfaces with the eyes open or closed.     

Wii balance board exercise improves balance and lower limb muscle strength of overweight young adults

[Purpose] The potential health benefits of the Nintendo Wii balance board exercise have been widely investigated. However, no study has been conducted to examine the benefits of Wii exercise for overweight young adults. The aim of this study was to investigate the effect of exercise performed on a Nintendo Wii balance board on the balance and lower limb muscle strength in overweight young adults. [Subjects and Methods] Within-subject repeated measures analysis was used. Sixteen young adults (aged 21.87±1.13 years, body mass index 24.15 ± 0.50 kg/m²) were recruited. All subjects performed an exercise program on a Wii balance board for 8 weeks (30 min/session, twice a week for 8 weeks). A NeuroCom Balance Master and a hand-held dynamometer were used to measure balance performance and lower limb muscle strength. [Results] According to the comparison of pre- and post-intervention measurements, the Wii balance board exercise program significantly improved the limit of stability parameters. There was also a significant increase in strength of four lower-limb muscle groups: the hip flexor, knee flexor, ankle dorsiflexor and ankle plantarflexor. [Conclusion] These findings suggest that a Wii balance board exercise program can be used to improve the balance and lower limb muscle strength of overweight young adults.Key words: Wii balance board, Muscle strength, Overweight     

Handgrip strength dominance is associated with difference in forearm muscle size

[Purpose] It is unknown whether handgrip strength dominance is related to the size of the forearm flexor muscles. The purpose of the present study was to investigate the relationship between side-by-side differences in handgrip strength and forearm muscle thickness. [Subjects] Thirty-one young women (26 right handed and 5 left handed) between the ages of 20 and 33 years volunteered to participate. [Methods] Two muscle thicknesses (forearm-ulna and forearm-radius muscle thicknesses) were measured using B-mode ultrasound at the anterior forearm on both sides of the body. Handgrip strength was also measured on both sides. [Results] The side-by-side difference in handgrip strength was 10.2% for the right-handed group, meaning the right hand was stronger. However, the left hand of the left-handed group was 7.8% stronger compared with their right hand. There was a significant positive correlation between side-by-side differences in handgrip strength and forearm-ulna muscle thickness (r = 0.765) and between handgrip strength and forearm-radius muscle thickness (r = 0.622). [Conclusion] Our results indicate that side-by-side differences in forearm muscle size may strongly contribute to handgrip strength dominance.Key words: Handgrip strength, B-mode ultrasound, Muscle thickness     

Visual Biofeedback Balance Training Using Wii Fit after Stroke: A Randomized Controlled Trial

[Purpose] The aim of the present study was to investigate the effect of balance training with visual biofeedback on balance, body symmetry, and function among individuals with hemiplegia following a stroke. [Subjects and Methods] The present study was performed using a randomized controlled clinical trial with a blinded evaluator. The subjects were twenty adults with hemiplegia following a stroke. The experimental group performed balance training with visual biofeedback using Wii Fit^® together with conventional physical therapy. The control group underwent conventional physical therapy alone. The intervention lasted five weeks, with two sessions per week. Body symmetry (baropodometry), static balance (stabilometry), functional balance (Berg Balance Scale), functional mobility (Timed Up and Go test), and independence in activities of daily living (Functional Independence Measure) were assessed before and after the intervention. [Results] No statistically significant differences were found between the experimental and control groups. In the intragroup analysis, both groups demonstrated a significant improvement in all variables studied. [Conclusion] The physical therapy program combined with balance training involving visual biofeedback (Wii Fit^®) led to an improvement in body symmetry, balance, and function among stroke victims. However, the improvement was similar to that achieved with conventional physical therapy alone.Key words: Postural balance, Stroke, Visual biofeedback     

Isokinetic Training Effect of Ankle Positions on Knee Extensor Strength

[Purpose] The purpose of this study was to determine which ankle position most influences knee extensor strength in training programs for strengthening the knee extensors using three different active ankle positions. [Subjects] Twenty-one healthy adults (6 males and 15 females) participated in this study. [Methods] Subjects were trained isokinetically in knee extension and flexion at 70 or 80% of 1RM under three actively and naturally fixed, contracted ankle conditions: dorsiflexion, plantarflexion, and resting position. After each group successfully executed the training four times a week for three weeks, mean peak torque (PT) and total work (TW) variables were measured and compared at 60°/sec and 180°/sec among the three groups. [Results] Significant differences were revealed in knee extensor TW at 60°/sec, PT and TW at 180°/sec, with the greatest PT and TW observed with the ankle in active dorsiflexion position. [Conclusion] These results suggest that active ankle dorsiflexion in a knee strength training program may be more effective at increasing knee extensor strength than a resting or plantarflexion position.Key words: Ankle position, Knee extensor strength, Isokinetic training     

The effects of ageing on functional capacity and stretch-shortening cycle muscle power

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity.Key words: Stretch-shortening cycle muscle power, Physical function, Ageing     

Effect of isotonic and isokinetic exercise on muscle activity and balance of the ankle joint

[Purpose] This study was performed to examine how the balance of lower limbs and the muscle activities of the tibialis anterior (TA), the medial gastrocnemius (GCM), and the peroneus longus (PL) are influenced by isotonic and isokinetic exercise of the ankle joint. [Subjects] The subjects of this study were healthy adults (n=20), and they were divided into two groups (isotonic=10, isokinetic=10). [Methods] Isotonic group performed 3 sets of 10 contractions at 50% of MVIC and Isokinetic group performed 3 sets of 60°/sec. Muscle activity was measured by EMG and balance was measured by one-leg standing test. [Results] For muscle activity, a main effect of group was found in the non-dominant TA, and the dominant TA, GCM and PL. For balance, a main effect of time was found in both groups for the sway area measured support was provided by the non-dominant side. [Conclusion] In terms of muscle activity, the two groups showed a significant difference, and the isokinetic group showed higher muscle activities. In terms of balance, there was a significant difference between the pre-test and the post-test. The results of this study may help in the selection of exercises for physical therapy, because they show that muscle activity and balance vary according to the type of exercise.Key words: Isotonic, Isokinetic, Balance     

The Effect of Ankle Taping and Balance Exercises on Postural Stability Indices in Healthy Women

[Purpose] The purpose of this study was to compare the effect of ankle taping and balance exercises on postural stability indices in healthy women. [Subjects and Methods] Thirty healthy female students were randomly assigned into two equal groups: ankle taping and balance exercise. The balance exercise group performed balance exercises for 6 weeks, with 3 sessions per week and each session lasting 40 minutes. Ankle joint taping was performed for 6 weeks and was renewed three times a week. Before and after the interventions, overall, anteroposterior, and mediolateral stability indices were measured with a Biodex Balance System in bilateral and unilateral stance positions with the eyes open and closed. [Results] In the taping group during bilateral standing with the eyes closed, the overall stability index changed from 6±1.4 to 4.8±1.3, anteroposterior stability index changed from 4.2±1.27 to 3.4±0.97, and mediolateral stability index changed from 3.2±0.75 to 2.7± 0.7. In the balance exercise group during bilateral standing with the eyes closed, the overall stability index changed from 5.7±1.69 to 4.5±1.94, anteroposterior stability index changed from 4.1±1.61 to 3±1.21, and mediolateral stability index changed from 3.5±1.4 to 2.2± 1.3. No significant difference was seen between the two groups regarding any study variables. [Conclusion] The results showed that compared with the taping technique, balance training increases postural stability in the majority of the studied balance situations.Key words: Balance exercise, Taping, Biodex     

Aerobic exercise training in modulation of aerobic physical fitness and balance of burned patients

[Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20–40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20–40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for 60 min and participated in a traditional physical therapy program, and group B (n=15), which only participated in a traditional exercise program 3 days/week. Maximal aerobic capacity, treadmill time, and Berg balance scale were measured before and after the study. [Results] In both groups, the results revealed significant improvements after treatment in all measurements; however, the improvement in group A was superior to that in group B. [Conclusion] The results provide evidence that aerobic exercises for adults with healed burn injuries improve aerobic physical fitness and balance.Key words: Aerobic exercise, Aerobic physical fitness, Burn injury     

Effects of a multifactorial fall prevention program on balance,gait, and fear of falling in post-stroke inpatients

[Purpose] This study investigated the effects of a multifactorial fall prevention program on balance, gait, and fear of falling in stroke patients. [Subjects] Twenty-five stroke patients were divided randomly into multifactorial fall prevention program group (n=15) and control treadmill group (n=10). [Methods] All interventions were applied for 30 min, five times per week, for five weeks. The fall prevention program included interventions based on the “Step Up to Stop Falls” initiative and educational interventions based on the Department of Health guidelines. For those in the treadmill group, the speed was increased gradually. The Korean falls efficacy scale and Korean activities-specific balance confidence scale were used to assess fear of falling. To assess balance and walking ability, the Korean performance-oriented mobility assessment scale and the 10-m and 6-minute walk tests were used. [Results] The fall prevention program interventions were found to be very effective at improving gait, balance, and fear of falling compared with the treadmill intervention and therefore seem appropriate for stroke patients. [Conclusion] A multifactorial fall prevention program is effective at improving balance, gait ability, and fear of falling. It is a more specific and broad intervention for reducing falls among inpatients in facilities and hospitals.Key words: Multifactorial fall prevention, Balance, Gait ability     

Risk Factors for Incident Fracture in Older Adults With Type 2 Diabetes: The Framingham Heart Study

OBJECTIVETo identify risk factors for fracture in type 2 diabetes.RESEARCH DESIGN AND METHODSThis prospective study included members of the Framingham Original and Offspring Cohorts. Type 2 diabetes was defined as fasting plasma glucose >125 mg/dL or use of type 2 diabetes therapy. We used repeated-measures Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% CIs for associations between potential predictors and incidence of fragility fracture.RESULTSParticipants included 793 individuals with type 2 diabetes. Mean ± SD age was 70 ± 10 years; 45% were women. A total of 106 incident fractures occurred over 1,437 observation follow-up intervals. Fracture incidence increased with age (adjusted HRs 1.00, 1.44 [95% CI 0.65, 3.16], and 2.40 [1.14, 5.04] for <60, 60–70, and >70 years, respectively; P_trend = 0.02), female sex (2.23 [1.26, 3.95]), HbA_1c (1.00, 2.10 [1.17, 3.75], and 1.29 [0.69, 2.41] for 4.45–6.46% [25–47 mmol/mol], 6.50–7.49% [48–58 mmol/mol], and 7.50–13.86% [58–128 mmol/mol]; P_trend =0.03), falls in past year (1.00, 1.87 [0.82, 4.28], and 3.29 [1.34, 8.09] for no falls, one fall, and two or more falls; P_trend =0.03), fracture history (2.05 [1.34, 3.12]), and lower grip strength (0.82 [0.69, 0.99] per 5-kg increase). Femoral neck bone mineral density, BMI, smoking, physical function, chronic diseases, medications, and physical function were not associated with fracture incidence.CONCLUSIONSPrior falls, fractures, low grip strength, and elevated HbA_1c are risk factors for fractures in older adults with type 2 diabetes. Evaluation of these factors may improve opportunities for early intervention and reduce fractures in this high-risk group.     

Decreasing fall risk in spinocerebellar ataxia

[Purpose] Spinocerebellar ataxia consists of a group of autosomal dominant disorders that cause progressive degeneration, mainly in the cerebellum and its connections. Falls, which are a significant concern of this condition, reduce patients’ mobility, deteriorate their health and have physical and social consequences. The aim of this study was to test the effectiveness of a modified protocol for improving balance and diminishing the fall risk of spinocerebellar ataxia patients exclusively. [Subjects and Methods] Exercises aiming to improve static and dynamic balance, whole body movements, measures to prevent falls and falling strategies were performed twice per week for four weeks by 11 spinocerebellar ataxia patients. Balance was evaluated using the Berg Balance Scale. [Results] The results show that there was a significant increase in Berg Balance Scale scores after the interventions (Wilcoxon p=0.0034). [Conclusion] This study demonstrated that the modified protocol is effective at reducing the fall risk of spinocerebellar ataxia patients. This protocol may be a useful option for appropriately coping with falls caused by spinocerebellar ataxia.Key words: SCA, Balance, Physical therapy     

Balance Improvement by Strength Training for the Elderly

[Purpose] Aging is associated with a progressive decline in overall muscle strength. Loss of lower limb strength leads to an increased risk of falls and a sedentary lifestyle. The purpose of this study was to investigate whether lower limb strengthening exercise leads to improved lower limb strength and balance function for the elderly. [Subjects] From a total of 74 respondents, 50 subjects were randomly assigned to either a training group (n = 30) or a control group (n = 20). The subjects ranged in age from 65 to 82 years. A randomized controlled trial compared the effects of strengthening exercise and balance function. [Methods] Leg extension and lower curl exercises were performed during the 12-week study. [Results] After training, the lower limb strength and balance of the individuals in the training group had significantly improved compared to the baseline. [Conclusion] Improvement in lower limb strength may lead to balance enhancement in neurologically intact older persons.Key words: Balance, Elderly, Strengthening exercise     

The effects of ankle joint muscle strengthening and proprioceptive exercise programs accompanied by functional electrical stimulation on stroke patients’ balance

[Purpose] The purpose of the present study was to examine the effects of ankle joint muscle strengthening and proprioceptive exercises accompanied by functional electrical stimulation on stroke patients’ balance ability. [Methods] For six weeks beginning in April 2015, 22 stroke patients receiving physical therapy at K Hospital located in Gyeonggi-do were divided into a functional electrical stimulation (FES), ankle proprioceptive exercise and ankle joint muscle strengthening exercise group (FPS group) of 11 patients and an FES and stretching exercise group (FS group) of 11 patients. The stimulation and exercises were conducted for 30 min per day, five days per week for six weeks. Balance ability was measured using a BioRescue and the Berg balance scale, functional reach test, and the timed up-and-go test were also used as clinical evaluation indices. Repeated measures ANOVA was conducted to examine differences between before the exercises and at three and six weeks after beginning the exercises within each group, and the amounts of change between the two groups were compared. [Results] In the comparison within each group, both groups showed significant differences between before and after the experiment in all the tests and comparison between the groups showed that greater improvement was seen in all values in the FPS group. [Conclusion] In the present study, implementing FES and stretching exercises plus ankle joint muscle strengthening and proprioceptive exercises was more effective at improving stroke patients balance ability than implementing only FES and stretching exercises.Key words: Proprioceptive, Strengthening, Stroke     

Lower-extremity muscle forces measured by a hand-held dynamometer and the risk of falls among day-care users in Japan: using multinomial logistic regression analysis

PURPOSE: To assess the relationship between the lower extremity muscle forces and risk of falls among the elderly who were using day-care services in the long-term care insurance system. METHOD: The study population comprised 96 women aged 69 - 91 years. At baseline, we assessed ADL, functional capacity, isometric muscle forces of knee extension and ankle dorsiflexion obtained with a hand-held dynamometer. After 1 year, we asked subjects about falls during the follow up period. RESULTS: In univariate analysis, only the knee extensor strength (p = 0.003) and ankle dorsiflexor strength (p = 0.02) differed significantly according to the fall status. After adjustment for age using multinomial logistic regression analysis, the weak quadriceps group was 7.50 times more likely than the strong group to fall once (p = 0.02), and 5.00 times more likely to fall twice or more (p = 0.02). The weakest ankle dorsiflexor group was 5.09 times more likely than the strongest group to fall twice or more (p = 0.05). CONCLUSIONS: Our results indicated that the forces of knee extensor and ankle dorsiflexor were strongly associated with falls among day-care users. Physiotherapy should focus on the lower-extremity muscle strength to prevent falls and deterioration of physical ability among elderly persons who are partially dependent and need support.     

Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral One-legged Standing Balance of Adults

[Purpose] The purpose of the current study was to investigate the changes in one-legged standing balance of the ipsilateral lower limb following unilateral isokinetic strength training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to either a training group or a control group, so that each group included 15 subjects. Subjects in the training group performed unilateral ankle isokinetic exercises of the dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral one-legged standing balance was evaluated before and after the intervention with three stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index (APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI). [Results] Comparison of pre- and post-test data revealed significant improvements in strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening exercise can be considered as a form of exercise that may assist individuals with improvement of balance.Key words: Postural balance, Isokinetic exercise, Strength training