Effect of Stationary Cycle Exercise on Gait and Balance of Elderly Women

[Purpose] A stationary bicycle exercise and a treadmill exercise were conducted in order to determine the effect of these exercises on the balance and walking ability of elderly women. [Subjects and Methods] Twenty-four elderly women aged 65 or older were equally assigned to a stationary bicycle exercise group and a treadmill exercise group, and they performed exercise three times per week for 8 weeks for 20 minutes each time. In order to examine gait, step length and time were measured as parameters of walking ability, and in order to examine dynamic balance, subjects were evaluated with the Berg balance scale (BBS). [Results] After the intervention, step time and step length and BBS significantly increased significantly decreased, in both groups. A comparison of BBS after the intervention between the two groups revealed that the stationary bicycle group showed larger increases than the treadmill group. [Conclusion] The stationary bicycle exercise group and treadmill exercise group showed significant improvements in gait and balance. Stationary bicycle exercise can help to prevent falls by improving the balance of elderly persons.Key words: Stationary bicycle exercise, Treadmill exercise, Elderly females     

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     

The effects of balance training and ankle training on the gait of elderly people who have fallen

[Purpose] The aim of this study was to examine the effects of balance training and muscle training around the ankle joints on the gait of elderly people who have experienced a fall. [Subjects] Twenty-six elderly people with a risk of falling and a Berg Balance Scale score of 37 to 50 points who had experienced a fall in the last year were randomly and equally assigned to either a balance training group or an ankle training group. The balance training group received training on a hard floor, training while maintaining balance on a cushion ball in a standing position, and training while maintaining balance on an unstable platform in a standing position; the ankle training group received training to strengthen the muscles around the ankle joints and conducted stretch exercise for the muscles around the ankle joints. [Results] There were significant changes in gait velocity, step length, and stride length in the balance training group after the intervention; there were significant changes in gait velocity, cadence, step time, cycle time, step length, and stride length in the ankle training group after the intervention. In a between-group comparison, the gait velocity of the balance training group showed a significant improvement compared with the ankle training group. [Conclusion] Both balance training and ankle joint training are effective in enhancing the gait ability of elderly people with a risk of falling; in particular, balance training is effective in improving the gait velocity of elderly people who have experienced a fall compared with ankle joint training.Key words: Elderly people, Balance training, Ankle training     

Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: a multi-centre controlled trial.

OBJECTIVE: To determine whether an exercise programme provided by public health nurses is effective in improving physical function and psychological status in elderly people, in reducing falls and risk factors for falls in elderly people, and whether the intervention is a feasible programme within the community. DESIGN: Controlled intervention trial. SUBJECTS: Participants included 144 persons in the intervention group and 124 persons in the control group, who were living at home, aged over 65 years, and with 5 or more risk factors for falls identified using the questionnaire for fall assessment (Suzuki). METHODS: For participants in the intervention group, an exercise programme was provided by public health nurses. This comprised a weekly exercise class of 2 hours for 17 weeks, supplemented by daily home exercises. Number of risk factors, physical function and psychological status were compared between the intervention and control groups before and after intervention. The number of further falls during the intervention was also compared between the 2 groups. RESULTS: The programme significantly improved physical function and emotional status, and reduced the number of falls and risk factors for falls. The excellent adherence rate represented broad acceptance of the intervention. CONCLUSION: The intervention programme was effective and feasible to operate in the community.     

Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial

Batchelor FA, Hill KD, Mackintosh SF, Said CM, Whitehead CH. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial.ObjectivesTo determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy.DesignA single blind, multicenter, randomized controlled trial with 12-month follow-up.SettingParticipants were recruited after discharge from rehabilitation and followed up in the community.ParticipantsParticipants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation.InterventionsTailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85).Main Outcome MeasuresPrimary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy.ResultsThere was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60–1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome.ConclusionsThis multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group.     

Long-term locomotor training for gait and balance in a patient with mixed progressive supranuclear palsy and corticobasal degeneration

BACKGROUND AND PURPOSE: Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are slowly progressive tauopathies characterized by impaired balance, disturbances in gait, and frequent falls, among other features. Wheelchair dependence is an inevitable outcome in people with these disorders. Insufficient evidence exists regarding the effectiveness of exercise in the management of people with these disorders. This case report describes a program of exercise and long-term locomotor training, using a treadmill (both with and without body-weight support), to reduce falls and improve the balance and walking ability of a patient with mixed PSP and CBD features. CASE DESCRIPTION: Six years after diagnosis with mixed PSP and CBD features, the client, a 72-year-old dentist, was seen for physical therapy for asymmetric limb apraxia, markedly impaired balance, and frequent falls during transitional movements. INTERVENTION: Over a 2.5-year period, intervention included routine participation in an exercise group for people with Parkinson disease (mat exercise and treadmill training) and intermittent participation in individual locomotor training on a treadmill. The exercise group met for 1 hour, twice weekly. The individual treadmill sessions lasted 1 hour, once weekly, for two 14-week periods during the follow-up period. OUTCOMES: Over the 2.5-year period, fall frequency decreased, and tests of functional balance showed improved limits of stability (functional reach tests) and maintained balance function (Berg Balance Scale). Tests of walking performance showed only slight declines. A 4-wheeled walker was introduced and accepted by the client early in the intervention period. The client, with supervision, remained ambulatory with this wheeled walker in the community. DISCUSSION: In this case report of a person with mixed PSP and CBD features, a physical therapy intervention, which included locomotor training using a treadmill and a long-term exercise program of stretching and strengthening, appears to have improved some dimensions of balance, slowed the rate of gait decline, prevented progression to wheelchair dependence, and decreased falls. Contrary to the expected decline in function, this client maintained independent mobility over a 2.5-year period. An ongoing, intensive program of exercise and locomotor training may help people with PSP and CBD maintain upright balance, decrease falls, and decrease the rate of decline of ambulation.     

奥塔戈运动在预防出院后老年脑卒中患者跌倒中的应用效果

目的 研究奥塔戈运动对出院后老年脑卒中患者跌倒效能、平衡能力、生活自理能力和跌倒发生情况的影响。方法 选取我院神经内科2018.7.1～2020.6.30符合研究标准的出院患者80例随机分为观察组和对照组,每组40例,在院期间对2组患者均进行常规防跌倒措施,出院后均进行常规电话、微信及门诊随访,观察组在对照组基础上接受6个月的奥塔戈运动（OEP）干预。比较两组患者在干预前后跌倒效能、平衡能力、生活自理能力和跌到发生的情况,评价奥塔戈运动在预防出院后老年脑卒中患者跌倒中的效果。结果 干预前两组患者跌倒效能、平衡能力、Barthel生活自理能力评分及跌倒发生率比较,均无差异(P>0.05),干预6个月后,观察组与对照组,跌倒效能、平衡能力、Barthel生活自理能力评分与干预前比较,均有改善(P<0.05),且观察组的改善更为明显(P<0.05),而跌倒发生率无明显差异（P>0.05）。结论 6个月的奥塔戈运动干预,能够提高出院后老年脑卒中患者的跌倒效能、平衡能力和生活自理能力,但能否降低跌倒发生率,有待进一步研究。     

The Effects of Augmented Reality-based Otago Exercise on Balance,Gait, and Falls Efficacy of Elderly Women

[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.Key words: Augmented reality, Otago exercise, Falls efficacy     

Reducing falls in elderly people: A review of exercise interventions

Falling by elderly people constitutes a serious issue with potential consequences of injury, disability, and challenges to independence. Interventions aimed at reducing falls by improving physical abilities are widely reported. Current evidence suggests that intervention programmes matched to the elderly individual's risk profile, including exercise for strength, balance, and gait problems, can result in significant fall reduction. This article selectively reviews the literature reporting exercise strategies to reduce falls by elderly people. Beneficial programme components and issues relevant to the clinical application of these findings are highlighted.     

The Effects of Hippotherapy on Elderly Persons’ Static Balance and Gait

[Purpose] The aim of this study was to examine the effects of hippotherapy on elderly persons’ static balance and gait. [Subjects and Methods] Twenty-two elderly persons residing in the community were randomly divided into a hippotherapy group and a treadmill group and they conducted exercise for eight weeks. [Results] Step lengths increased significantly, and step time and sway path lengths significantly decreased in both groups. A comparison of sway path lengths after the intervention between the two groups revealed that the hippotherapy group showed larger decreases than the treadmill group. [Conclusion] The results of this study indicate that hippotherapy may improve the static balance and gait of elderly persons residing in the community.Key words: Elderly, Balance, Hippotherapy     

Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation

OBJECTIVE: To evaluate the clinical effectiveness and implementation of a falls prevention exercise programme for preventing falls in the subacute hospital setting. DESIGN: Randomized controlled trial, subgroup analysis. PARTICIPANTS: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a falls prevention exercise programme when enrolled in a larger randomized controlled trial of a falls prevention programme. METHODS: Participants in both the control and intervention groups who were recommended for the exercise programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. Participation rates in the exercise programme were also recorded. RESULTS: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident. CONCLUSION: This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting.     

Supported treadmill training for gait and balance in a patient with progressive supranuclear palsy

BACKGROUND AND PURPOSE: Impaired balance, gait disturbances, and frequent falls are common problems in people with progressive supranuclear palsy (PSP). This case report describes the use of a modified body weight support treadmill training program to reduce falls and improve the balance and gait of a patient with PSP. CASE DESCRIPTION: The patient was a 62-year-old man diagnosed with PSP. His major problems were impaired balance and frequent, abrupt falls. METHODS: Physical therapy included walk training, balance perturbation, and step training using body weight support with a treadmill. Training sessions lasted 11/2 hours and occurred 3 days a week for 8 weeks. Fall incidence, balance, and gait were assessed before, during, and after the program. OUTCOMES: The patient reported fewer falls during and after training. Balance and gait improved after training. DISCUSSION: This case report is the first to report fall reduction, improved gait, and improved balance following physical therapy for a person with PSP.     

Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial

OBJECTIVES: To determine the effects of moderate intensity group-exercise programs on falls, functional performance, and disability in older adults; and to investigate the influence of frailty on these effects. DESIGN: A 20-week, multicenter randomized controlled trial, with 52-week follow-up. SETTING: Fifteen homes for the elderly. PARTICIPANTS: Two hundred seventy-eight men and women (mean age +/- standard deviation, 85+/-6y). INTERVENTIONS: Two exercise programs were randomly distributed across 15 homes. The first program, functional walking (FW), consisted of exercises related to daily mobility activities. In the second program, in balance (IB), exercises were inspired by the principles of Tai Chi. Within each home participants were randomly assigned to an intervention or a control group. Participants in the control groups were asked not to change their usual pattern of activities. The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks. MAIN OUTCOME MEASURES: Falls, Performance Oriented Mobility Assessment (POMA), physical performance score, and the Groningen Activity Restriction Scale (GARS) (measuring self-reported disability). RESULTS: Fall incidence rate was higher in the FW group (3.3 falls/y) compared with the IB (2.4 falls/y) and control (2.5 falls/y) groups, but this difference was not statistically significant. The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail (hazard ratio [HR] = 2.95; 95% confidence interval [CI], 1.64-5.32). For participants who were classified as being pre-frail, the risk of becoming a faller decreased; this effect became significant after 11 weeks of training (HR = .39; 95% CI, .18-.88). Participants in both exercise groups showed a small, but significant improvement in their POMA and physical performance scores. In the FW group, this held true for the GARS score as well. Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores. CONCLUSIONS: Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail, but not in frail elderly.     

Development of an exercise program for fall prevention for elderly persons in a long-term care facility

Aim: The purpose of this study was to develop an exercise program for elderly individuals in a long‐term care facility. Developed through the synthesis of evidence‐based nursing with the use of available research related to falls and exercise, the program was designed to increase balance, mobility, and muscle strength in the lower extremities in order to prevent falls and improve the self‐efficacy of the patients. Methods: We developed an exercise program consisting of a warm‐up, static stretching, muscle strengthening in the lower extremities, toe exercises, proprioceptive neuromuscular facilitation, and cool‐down. The study design was a prospective clinical trial. The intervention period was 3 months, with the outcomes measured before and after intervention and 3 months after cessation of the intervention. The 30 participants were elderly residents of a long‐term care facility, 16 of whom were in the intervention group and 14 of whom were in the control group. The outcome values were mobility, muscle strength in the lower extremities, postural sway, fall efficacy, and the number of fallers and falls. The Friedman test was used to analyze the effectiveness of the outcomes. Results: The intervention group showed increased balance, maintained mobility, and showed a decreased number of fallers and falls, although the muscle strength and fall efficacy did not increase. No training‐related medical problems occurred. Conclusion: The exercise program was shown to be acceptable to use for the prevention of falls among elderly individuals in a long‐term care facility.     

Falls in the elderly: Part I, Gait

The aim of this study was to determine a gait profile of two groups of elderly adults: one with a history of falls and one without a history of falls. The following gait characteristics were identified: step frequency, stance time, swing time, double support time, step length, heel width, heel height, toe height, and hip, knee, and ankle angular excursion. The history of falls group was composed of 25 subjects (seven men and 18 women), and the no history of falls group was composed of 30 subjects (12 men and 18 women). Two 16-mm Locam cameras were used to film the subjects. Each subject was filmed while walking on a motorized treadmill at 4 km/h and 6 km/h. The film data were digitized on a sonic digitizer interfaced to a VAX computer. The ANOVA statistic indicated significant (p less than .05) difference between the two independent variables for heel width. There appears to be no significant relationship between the studied gait characteristics (other than heel width) and falls in apparently healthy elderly individuals.     

Kinematic effect of Nintendo WiiTM sports program exercise on obstacle gait in elderly women with falling risk

[Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Nintendo Wii^TM Sports in elderly at risk for falls. [Subjects and Methods] Twenty-four elderly women with at risk for falls were randomly divided into the control, lumbar stabilization exercise, and Nintendo Wii Sports groups. Static balance was measured by the Berg Balance Scale and functional reach test, dynamic balance by the timed up-and-go test, and obstacle negotiation function by crossing velocity and maximum vertical heel clearance. [Results] Both the lumbar stabilization exercise and Nintendo Wii Sports groups showed significant improvements in obstacle negotiation function after the exercise compared to the control group. Berg Balance Scale and functional reach test scores were greater in the lumbar stabilization exercise group, while the timed up-and-go test time was significantly better in the Nintendo Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Nintendo Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls.Key words: Elderly women, Falls, Nintendo Wii Sports     

The Effects of a Complex Exercise Program with the Visual Block on the Walking and Balance Abilities of Elderly People

[Purpose] The purpose of this study was to investigate the effect of a complex exercise program for elderly people who had experienced a fall on their balance, gait, vestibular senses, and proprioceptive senses when their visual sense was blocked. [Subjects and Methods] The subjects were 30 healthy elderly people aged 65 or older. They were equally and randomly divided into a visual block (VB) group (those whose eyes were covered) and a visual permission (VP) group. The subjects performed the complex exercise program for 30 minutes, twice a day, five day a week for 4 weeks a total of 20 times. Outcome measures were the10 meter walking test (10MWT), stair up/down test (SUDT), Berg balance scale (BBS), vestibular stepping test (VST), proprioception test (PT). [Results] After the intervention, the VB group showed improvements in 10MWT, VST, and PT. The VP group showed improvements in 10MWT and PT. The significant improvement in VST observed in the VB group was significantly greater than that in the VP group. [Conclusion] The complex exercise program for elderly people helped enhance their balance ability and gait, and improved their vestibular sense.Key words: Complex exercise, Elderly, Visual block     

医疗失效模式与效应分析在预防社区脑卒中跌倒中的应用

[目的]运用医疗失效模式与效应分析(HFMEA)方法对社区防跌倒管理流程进行改进并实施,以有效规避脑卒中患者跌倒高危因素,降低脑卒中患者跌倒发生率。[方法]选取2016年1-12月静安区某社区卫生服务中心管理的脑卒中患者163名。首先,进行脑卒中患者跌倒风险调查,了解跌倒发生情况,并进行多因素分析筛选跌倒高危因素;然后,采用HFMEA 方法,将上述调查对象随机分为二组,实施6个月干预,并对二组脑卒中患者首次入户随访时间、跌倒风险因素及跌倒次数进行评价。[结果]调查对象一年内跌倒发生率为31.29%,行走辅助用具、视力对日常的影响、对外界反应能力、脚无力是跌倒的独立危险因素,见表3。二组在首次入户干预时间、跌倒风险评估总分、跌倒次数方面存在显著差异 (P<0.05),见表4。[结论]运用医疗失效模式与效应分析(HFMEA)方法改进并实施社区防跌倒管理流程和控制方案,可降低跌倒风险,减少跌倒发生。     

Effects of square-stepping exercise on motor and cognitive function in older adults — A systematic review and meta-analysis

ObjectivesTo document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults.MethodsFive online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function.ResultsTen articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function.ConclusionIn older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.     

On the Move clinic: A fall prevention nurse practitioner-driven model of care

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.