柔韧性训练对老年糖尿病周围神经病变患者平衡功能的影响

目的 探讨柔韧性训练对老年糖尿病周围神经病变患者平衡功能的影响。方法 在上海市两家社区卫生服务中心招募老年糖尿病周围神经病变患者88例，采用抽签法分为干预组(45例)和对照组(43例)。对照组接受社区糖尿病健康教育和常规运动干预，干预组接受社区糖尿病健康教育和柔韧性训练，均干预3个月，观察两组踝关节活动度、平衡功能及步态稳定性。结果 干预组43例、对照组42例完成研究。干预3个月后，干预组闭眼单足站立测试时间、起立-行走计时测试时间、足底压力中心轨迹曲线异常比例及全足压力变化曲线比例显著优于对照组(均P<0.05)。结论 柔韧性训练可改善老年糖尿病周围神经病变患者的平衡功能及步态稳定性。     

四方联动防跌护理在社区跌倒高危老年人中的应用

目的探讨专科护士-社区护士-个体-家庭四方联动防跌护理模式在社区跌倒高危老年人中的应用与效果。方法选取深圳市龙岗区的2个社区,随机分为观察组和对照组,从两个社区登记建档的跌倒高风险老年居民中分别随机抽选45名进行干预。观察组采用"专科护士-社区护士-个体-家庭"四方联动推进的综合干预方案。对照组接受社区防跌倒常规护理。于干预前及干预后12个月使用修订版社区老年人跌倒危险评估量表、步态和平衡测试量表对两组老年人进行评测,记录两组1年内跌倒发生例次。结果干预期间跌倒发生情况:观察组1人次,对照组6人次。观察组步态和平衡测试得分提高,跌倒危险评估表得分降低,与对照组比较,差异有统计学意义(均P0.01)。结论四方联动的综合干预方案应用于社区居家老年人,能有效降低老年人跌倒风险,提升其防跌能力,对预防社区老年人跌倒的发生有积极作用。     

双重任务训练对养老院老年人步态与平衡功能的影响

目的 探讨双重任务训练对养老院老年人步态与平衡改善的效果。 方法 将养老院30例老年人按照随机数字表法分为观察组与对照组各15人。对照组按常规进行回春医疗保健操训练，观察组在常规训练基础上开展双重任务训练。于干预前和干预6周后进行步态参数测试及平衡测试。 结果 干预后，观察组步速、步长、双重任务步长、起立行走试验用时和双重任务起立行走试验用时、平衡功能评分显著优于对照组（P＜0.05，P＜0.01），两组双重任务步速及ABC平衡信心评分差异无统计学意义（均P＞0.05）。 结论 双重任务训练可改善养老院老年人的步态及综合平衡能力，但对其害怕跌倒心理的改善作用不显著。     

平衡功能训练对康复期脑卒中患者预防跌倒的作用

目的探讨平衡功能训练对康复期脑卒中患者跌倒预防的作用。方法将108例康复期脑卒中患者采用随机数字表法分为观察组与对照组各54例,对照组按常规进行康复训练,观察组在常规康复训练基础上实施静态坐位及站立的平衡功能训练。比较出院后3个月两组跌倒和Berg平衡量表得分情况。结果观察组跌倒发生率显著低于对照组,Berg平衡量表得分显著高于对照组(P0.05,P0.01)。结论对康复期脑卒中患者早期开展并长期坚持平衡功能训练,能有效提高患者身体平衡能力,降低跌倒的发生。     

老年人跌倒相关因素及三种防跌倒干预措施的效果分析

目的探讨三种干预模式对预防老年人跌倒效果的差异。方法收集2015年6月至2018年1月我院骨科中心收治的568例老年骨科患者为研究对象,根据有无跌倒史分为跌倒组175例和非跌倒组393例,统计分析可能导致患者跌倒的危险因素。在除部分存在明显异质性的病例,将纳入的128例跌倒组患者随机分为振动训练组(VT组)、平衡板训练组(BBT组)、单纯跌倒知识宣教组(KE组)和对照组各32例,对比分析3种干预措施的差异。对比分析3种干预措施的差异,如运动功能、肌肉力量、平衡力者、步行功能、日常生活等相关指标。结果以干预完成时间为截点,对照组出现1例新发跌倒,其余干预组均未出现跌倒病例。以干预完成后3个月为截点,对照组、VT组、BBT组、KE组分别出现2例、1例、2例、1例新发跌倒,四组新发跌倒率比较差异无统计学意义(P0.05)。干预后,对照组和KE组患者运动功能、肌肉力量、平衡力均无明显变化(P0.05);BBT组患者运动功能、肌力、平衡力均有明显改善,但握力无明显改变;VT组患者运动功能、平衡力恢复良好,但肌肉力量无改善;对照组和KE组患者步行能力、日常生活相关评分均无明显变化(P0.05);VT组和BBT组患者的步行能力及日常生活能力评分均有明显改善(P0.05),但工具性日常生活能力无明显变化(P0.05)。结论定期的振动训练和平衡板训练对存在跌倒高危因素骨科患者的运动能力及生活质量有明显改善作用,且全身振动训练效果更佳,单纯健康教育无明显意义。     

基于PASS理论的方步运动方案在卒中后认知障碍患者中的应用

目的 观察基于PASS理论构建的方步运动方案对卒中后认知障碍患者认知功能、平衡功能、跌倒风险的影响。方法 将卒中后认知障碍患者随机分为观察组41例，对照组39例。对照组实施常规专科护理、康复训练和认知训练，观察组在对照组基础上采取基于PASS理论构建的方步运动方案干预，比较两组干预效果。结果 干预1个月、3个月、6个月后，观察组蒙特利尔认知评估量表评分、Berg平衡量表评分显著高于对照组，Morse跌倒评估量表评分显著低于对照组(均P<0.05)。结论 基于PASS理论构建的方步运动方案能够改善卒中后认知障碍患者的认知功能、平衡能力，降低患者跌倒风险。     

Teach-back结合专科视频教育用于老年患者平衡功能训练

目的探讨Teach-back结合专科视频教育在老年患者平衡功能训练中的应用效果。方法将100例老年患者按入院时间分为对照组和观察组各50例。对照组实施常规健康教育、平衡功能训练和出院后回访,观察组将Teach-back结合专科视频教育用于平衡功能训练中。比较两组出院后3个月平衡功能训练掌握程度、依从性及Breg平衡量表得分、跌倒发生率。结果出院后3个月观察组平衡功能训练掌握程度、依从性、Breg平衡量表得分显著高于对照组(均P 0. 01);观察组出院后3个月内跌倒发生率低于对照组。结论 Teach-back结合专科视频教育可以有效提高老年患者平衡功能训练掌握程度和依从性,从而提高平衡能力,降低跌倒风险。     

基于循证的老年人团体防跌倒奥塔戈运动方案的构建与实施

目的提高社区老年人运动效能。方法依据最佳证据,结合社区老年人运动问题分析,构建"基于循证的老年人团体防跌倒奥塔戈运动方案",用于32名社区老年人运动实践。实施5个月后评价效果。结果 29名社区老年人完成全程研究,其平衡能力、跌倒效能、体能水平、跌倒风险、满意度得分及总分显著优于运动方案实施前(均P0.01)。结论基于循证的团体实践方案可有效改善社区老年人平衡、体能能力,从而降低跌倒风险。     

化疗诱导的周围神经病变患者多模式运动干预

目的 探讨多模式运动在化疗诱导的周围神经病变患者中的应用效果。方法 便利抽取82例结直肠癌化疗诱导的周围神经病变患者,按病区分为对照组和干预组各41例。对照组采用步行运动,每次30 min,每周至少3次;干预组采用多模式运动干预,每次30~40 min,每周至少3次。干预前及干预12周,采用化疗诱导的周围神经病变评估工具、Berg平衡量表、修正版跌倒效能量表、起立-行走计时测试 进行效果评价。结果 对照组38例、干预组36例完成研究。干预12周后,干预组患者化疗诱导的周围神经病变得分、Berg平衡得分<45分发生率、起立-行走计时测试结果显著低于对照组,跌倒自我效能得分显著高于对照组（均P＜0.05）。结论 多模式运动有利于改善结直肠癌患者化疗诱导的周围神经病变症状体验及对日常生活能力的影响,提高患者的平衡功能、跌倒自我效能和移动能力。     

脑卒中肢体功能障碍患者跌倒预防的核心稳定性康复训练

目的探讨脑卒中肢体功能障碍患者实施核心稳定性训练预防跌倒的方法及效果。方法将100例脑卒中患者按照入院时间顺序分成干预组和对照组各50例,对照组按照Morse跌倒风险评估结果,对高风险患者实施常规跌倒预防措施;干预组在此基础上加强功能康复训练的益处和跌倒预防的强化教育,并配合核心稳定性训练。结果干预4周后,干预组跌倒发生例数减少;患者肢体运动功能及日常生活活动能力得分显著优于本组干预前和对照组(均P0.01)。结论强化认知教育配合核心稳定性训练可提高脑卒中患者肢体功能及日常生活活动能力,从而降低跌倒发生风险。     

The Association of Flexibility,Balance, and Lumbar Strength with Balance Ability: Risk of Falls in Older Adults

The purpose of the present study was to determine the effects of a proprioceptive training program on older adults, as well as to analyze the association between flexibility, balance and lumbar strength (physical fitness test) with balance ability and fall risk (functional balance tests). This study was a controlled, longitudinal trial with a 12-week follow-up period. Subjects from a population of older adults were allocated to the intervention group (n = 28) or to the usual care (control) group (n = 26). Subjects performed proprioceptive training twice weekly (6 specific exercises with Swiss ball and BOSU). Each session included 50 minutes (10 minutes of warm-up with slow walk, 10 minutes of mobility and stretching exercises, 30 minutes of proprioceptive exercises). The outcome variables were physical fitness (lower-body flexibility, hip-joint mobility, dynamic balance, static balance, and lumbar strength) and functional balance (Berg scale and Tinetti test). The experimental group obtained significantly higher values than the control group in lower-body flexibility, dynamic balance, and lumbar strength (p = 0.019, p < 0.001, and p = 0.034 respectively). Hip-joint mobility, dynamic balance, and lumbar strength were positively associated with balance ability (p < 0.001, p < 0.001, and p = 0.014, respectively) and the prevention of falls (p = 0.001, p < 0.001, and p = 0.017 respectively). These findings suggest that a 12-week proprioception program intervention (twice a week) significantly improves flexibility, balance, and lumbar strength in older adults. Hip-joint mobility, dynamic balance and lumbar strength are positively associated to balance ability and the risk of falls in older adults. This proprioceptive training does not show a significant improvement in hip-joint mobility or static balance.

Key points

• A 12-week proprioceptive intervention program (two times per week) significantly improves flexibility, balance, and lumbar strength in older adults.
• The risk of falls and balance ability are significantly improved after a training program with Bosu and Swiss ball in older adults.
• An improvement in joint mobility, dynamic balance and lumbar strength is positively associated with balance ability and improved fall risk in older adults.
• A 12-week proprioceptive intervention program (two times per week) does not show a significant improvement in hip-joint mobility and static balance.

Key words: Proprioception, physical condition, training, physical qualities, swiss ball     

Preventative effect of exercise against falls in the elderly: a randomized controlled trial

Summary  The present study was conducted to determine the effect of 5-month exercise program on the prevention of falls in the elderly. The exercise training, which consisted of calisthenics, body balance training, muscle power training, and walking ability training 3 days/week improved the indices of the flexibility, body balance, muscle power, and walking ability and reduced the incidence of falls compared with non-exercise controls. The present study showed the beneficial effect of the exercise program aimed at improving flexibility, body balance, muscle power, and walking ability in preventing falls in the elderly. Introduction  The present study was conducted to determine the effect of exercise on the prevention of falls in the elderly. Methods  Sixty-eight elderly ambulatory volunteers were randomly divided into two groups: the exercise and control groups. The daily exercise, which consisted of calisthenics, body balance training (tandem standing, tandem gait, and unipedal standing), muscle power training (chair-rising training), and walking ability training (stepping), were performed 3 days/week only in the exercise group. No exercise was performed in the control group. Results  After the 5-month exercise program, the indices of the flexibility, body balance, muscle power, and walking ability significantly improved in the exercise group compared with the control group. The incidence of falls was significantly lower in the exercise group than in the control group (0.0% vs. 12.1%, P = 0.0363). The exercise program was safe and well tolerated in the elderly. Conclusions  The present study showed the beneficial effect of the exercise program aimed at improving flexibility, body balance, muscle power, and walking ability in preventing falls in the elderly.     

平衡及肌力运动操降低老年患者跌倒

目的探讨平衡及肌力运动操降低老年患者跌倒的效果。方法将80例具有一定行走能力的老年患者随机分为对照组和观察组各40例。对照组采用常规预防跌倒的措施并强调加强散步等体育锻炼;观察组在此基础上,进行平衡及肌力运动操训练。结果训练8周后观察组Berg平衡量表评分及Motricity指数中下肢肌力积分显著高于对照组(均P0.01);观察组住院期间跌倒发生率低于对照组。结论平衡及肌力运动操能提高老年患者的平衡能力及肌力,从而降低老年患者的跌倒风险。     

Long-Term Exercise in Older Adults: 4-Year Outcomes of Music-Based Multitask Training

Prospective controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking. The present study aimed to assess the effects of long-term music-based multitask exercise (i.e., Jaques-Dalcroze eurhythmics) on physical function and fall risk in older adults. A 3-year follow-up extension of a 1-year randomized controlled trial (NCT01107288) was conducted in Geneva (Switzerland), in which 134 community-dwellers aged ≥65 years at increased risk of falls received a 6-month music-based multitask exercise program. Four years following original trial enrolment, 52 subjects (baseline mean ± SD age, 75 ± 8 years) who (i) have maintained exercise program participation through the 4-year follow-up visit (“long-term intervention group”, n = 23) or (ii) have discontinued participation following original trial completion (“control group”, n = 29) were studied. They were reassessed in a blind fashion, using the same procedures as at baseline. At 4 years, linear mixed-effects models showed significant gait (gait speed, P = 0.006) and balance (one-legged stance time, P = 0.015) improvements in the long-term intervention group, compared with the control group. Also, long-term intervention subjects did better on Timed Up & Go, Five-Times-Sit-to-Stand and handgrip strength tests, than controls (P < 0.05, for all comparisons). Furthermore, the exercise program reduced the risk of falling (relative risk, 0.69; 95 % confidence interval, 0.5–0.9; P = 0.008). These findings suggest that long-term maintenance of a music-based multitask exercise program is a promising strategy to prevent age-related physical decline in older adults. They also highlight the efficacy of sustained long-term adherence to exercise for falls prevention.     

Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention.The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fishers exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.     

'Osteo-cise: Strong Bones for Life': Protocol for a Community-based Randomised Controlled Trial of a Multi-modal Exercise and Osteoporosis Education Program for Older Adults at Risk of Falls and Fractures

ABSTRACT: BACKGROUND: Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition. METHODS: The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed. DISCUSSION: The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291.     

Effect of Home-Based Well-Rounded Exercise in Community-Dwelling Older Adults

The purpose of this study was to assess the efficacy of a home-based well-rounded exercise program (WREP) in older adults. Forty sedentary community-dwelling older adults were randomly assigned to an exercise group (n = 23; aged 62-80 yr, average: 69.2 ± 5.2; 12 men and 11 women) or a control group (n = 17; aged 63-85 yr, average: 70.1 ± 6.6; 5 men and 12 women). The exercise group performed a 12-wk WREP which included aerobic exercise (walking) on about 3 days·wk^-1 for 37 min·day^-1; elastic band-based resistance exercises for the major muscle groups on about 3 days·wk^-1 for 26 min; and flexibility exercises (stretching) on about 4 days·wk^-1 for 19 min·day^-1. General physical characteristics, functional strength (Arm Curl [AC], Chair Stand [CS]), dynamic balance and agility (Up & Go [UG]), flexibility (Back Scratch [BS], Sit & Reach [SR]), and endurance (12-min walk [12-MW]) were measured. Following the 12-wk home-based WREP, improvements were observed in AC, CS, UG, BS, SR and 12-MW for the exercise group but not for the control group. These results suggest that the home-based WREP can improve overall fitness in older adults.

Key Points

• Walking, elastic band exercise and stretching were prescribed as a Well-Rounded Exercise Program for older adults.
• By combining aerobic, resistance and flexibility exercises, a Well-Rounded Exercise Program was effective for improving endurance, functional strength, dynamic balance and agility, and flexibility.
• Community-based exercise classes motivated older adults to perform home-based exercises.

Key words: Physical fitness, aerobic exercise, resistance exercise, flexibility exercise, adherence     

干预映射用于老年患者预防跌倒自我管理的效果评价

目的提高老年患者预防跌倒自我管理行为。方法将258例老年住院患者随机分为对照组和观察组各129例。对照组给予常规防跌倒护理,观察组采用干预映射方法拟订老年患者预防跌倒自我管理健康教育项目并实施。于干预前及干预4周后评价老年患者预防跌倒自我管理行为得分。结果干预4周后,观察组跌倒预防自我管理行为总分显著高于对照组(P0.01)。结论应用干预映射方法设计老年患者预防跌倒自我管理健康教育项目并实施,能提高老年患者预防跌倒自我管理行为的能力。     

基于患者参与框架的住院老年患者跌倒预防干预策略的实施

目的 探讨基于患者参与框架的住院老年患者跌倒预防干预策略的实施效果.方法 根据住院时间将2019年1～6月收治的58例老年患者作为对照组,2019年7?12月收治的58例作为观察组.对照组按常规实施预防跌倒措施,观察组基于患者参与框架制订并实施住院老年患者跌倒预防干预策略,包括"告知、参与、赋权、合作及电子化信息支持"...