Balance Exercises Circuit improves muscle strength,balance, and functional performance in older women

This study introduces the Balance Exercises Circuit (BEC) and examines its effects on muscle strength and power, balance, and functional performance in older women. Thirty-five women aged 60+ (mean age = 69.31, SD = 7.35) were assigned to either a balance exercises group (BG, n = 14) that underwent 50-min sessions twice weekly, of a 12-week BEC program, or a wait-list control group (CG, n = 21). Outcome measures were knee extensor peak torque (PT), rate of force development (RFD), balance, Timed Up & Go (TUG), 30-s chair stand, and 6-min walk tests, assessed at baseline and 12 weeks. Twenty-three participants completed follow-up assessments. Mixed analysis of variance models examined differences in outcomes. The BG displayed improvements in all measures at follow-up and significantly improved compared with CG on, isokinetic PT60, PT180 (p = 0.02), RFD (p < 0.05), balance with eyes closed (p values range .02 to <.01) and TUG (p = 0.03), all with medium effect sizes. No changes in outcome measures were observed in the CG. BEC improved strength, power, balance, and functionality in older women. The BEC warrants further investigation as a fall prevention intervention.     

Effects of functional training on pain,leg strength,and balance in women with fibromyalgia

Aim: The aim of this study was to analyze the effect of 18-week functional training (FT) program consisting in two sessions a week of in-water exercise and one of on-land exercise on pain, strength, and balance in women with fibromyalgia.

Methods: A sample consisting of 36 fibromyalgia patients was included in the study. The patients were allocated randomly into the experimental group (EG, n = 20), and control group (CG, n = 16). Standardized field-based fitness tests were used to assess muscle strength (30-s chair stand and handgrip strength) and agility/dynamic balance and static balance. Fibromyalgia impact and pain were analyzed by Fibromyalgia Impact Questionnaire (FIQ), tender points (TPs), visual analog scale (VAS).

Results: We observed a significant reduction in the FIQ (p = 0.042), the algometer scale of TP (p = 0.008), TP (p < 0.001), and VAS (p < 0.001) in the EG. The EG shows better results in leg strength (p < 0.001), handgrip strength (p = 0.025), agility/dynamic balance (p = 0.032) and balance (p = 0.006).

Conclusions: An 18-week intervention consisting in two sessions of in-water exercise and one session of on-land exercise of FT reduces pain and improves functional capacity in FM patients. These results suggested that FT could play an important role in maintaining an independent lifestyle in patients with FM.     

Short-term, light- to moderate-intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial

OBJECTIVES: To assess the effects of an 8‐week exercise training program with a special focus on light‐ to moderate‐intensity resistance exercises (30–70% of one repetition maximum, 1RM) and a subsequent 4‐week training cessation period (detraining) on muscle strength and functional capacity in participants aged 90 and older. DESIGN: Randomized controlled trial performed during March to September 2009. SETTING: Geriatric nursing home. PARTICIPANTS: Forty nonagenarians (90–97) were randomly assigned to an intervention or control group (16 women and 4 men per group). INTERVENTION: Eight‐week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity. MEASUREMENTS: Primary outcome: 1RM leg press. Secondary outcomes: handgrip strength, 8‐m walk test, 4‐step stairs test, Timed Up and Go test, and number of falls. RESULTS: A significant group by time interaction effect (P=.02) was observed only for the 1RM leg press. In the intervention group, 1RM leg press increased significantly with training by 10.6 kg [95% confidence interval (CI)=4.1–17.1 kg; P=.01]. Except for the mean group number of falls, which were 1.2 falls fewer per participant in the intervention group (95% CI=0.0–3.0; P=.03), no significant training effect on the secondary outcome measures was found. CONCLUSION: Exercise training, even of short duration and light to moderate intensity, can increase muscle strength while decreasing fall risk in nonagenarians.     

The effect of balance training intervention on postural stability in children with asthma

Objective: Pulmonary rehabilitation is mainly focused on exercise training and breathing retraining in children with asthma. Conversely, balance training is not usually recommended for the treatment, although postural deficits were found in these patients. Therefore, this study assessed the effect of balance training intervention on postural stability in children with asthma. Methods: Nineteen children with mild intermittent asthma (age 11.1 ± 2.1 years, height 147.6 ± 13.9 cm, weight 41.8 ± 13.3 kg) were randomly assigned to an experimental group or a control group and completed a four-week physiotherapy program including breathing exercises and aerobic physical training (six times/week, 45 minutes). Both groups performed the same training, but only the experimental group underwent exercises on balance devices. The center of pressure (CoP) velocity in the anteroposterior (V_y) and mediolateral (V_x) directions, and total CoP velocity (V_tot) were recorded before and after training in the preferred and the adjusted stances under eyes open (EO) and eyes closed (EC) conditions. Results: The addition of balance intervention led to significant improvements of V_tot (p = 0.02, p = 0.04) in both types of stance, V_x in the preferred stance (p = 0.03) and V_y in the adjusted stance (p = 0.01) under EO conditions. Significant improvements were also found in V_y in the adjusted stance (p = 0.01) under EC conditions. Conclusions: Results of this study support the effectiveness of balance training as a part of physiotherapy treatment for improving balance performance, predominantly under EO conditions, in children with mild asthma.     

Effect of traditional resistance and power training using rated perceived exertion for enhancement of muscle strength,power, and functional performance

The present study compared the effects of 12 weeks of traditional resistance training and power training using rated perceived exertion (RPE) to determine training intensity on improvements in strength, muscle power, and ability to perform functional task in older women. Thirty healthy elderly women (60–75 years) were randomly assigned to traditional resistance training group (TRT; n = 15) or power training group (PT; n = 15). Participants trained twice a week for 12 weeks using six exercises. The training protocol was designed to ascertain that participants exercised at an RPE of 13–18 (on a 6–20 scale). Maximal dynamic strength, muscle power, and functional performance of lower limb muscles were assessed. Maximal dynamic strength muscle strength leg press (≈58 %) and knee extension (≈20 %) increased significantly (p < 0.001) and similarly in both groups after training. Muscle power also increased with training (≈27 %; p < 0.05), with no difference between groups. Both groups also improved their functional performance after training period (≈13 %; p < 0.001), with no difference between groups. The present study showed that TRT and PT using RPE scale to control intensity were significantly and similarly effective in improving maximal strength, muscle power, and functional performance of lower limbs in elderly women.     

Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

Purpose

This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program.

Methods

Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016).

Results

The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21–32) kg/m², FEV₁ 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC.

Conclusion

High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

     

Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial

The objective of this study was to determine whether an exercise intervention using a pedal exerciser is able to reduce disability in frail older patients with chronic obstructive pulmonary disease (COPD) during hospitalization due to an acute exacerbation.

This study was a randomized, single-blind clinical trial. Fifty-eight frail older patients admitted to hospital due to an acute exacerbation of COPD (AECOPD) were included in this study. All patients received standard medical and pharmacological care. Patients assigned to the intervention group also received an exercise intervention. The main outcome measures were balance, muscle strength, and exercise capacity.

Significant between-group differences were found in muscle strength (p = 0.028) and balance (p = 0.013) after the intervention. All the variables improved significantly (p < 0.05) in the exercise intervention group. In the intervention group, the mean difference in muscle strength between baseline and discharge was 10.47 N. Balance also improved, showing a mean difference of 7.56 seconds on the right leg and 6.57 seconds on the left leg. Exercise capacity improved as well, with a difference of 4.97 stands between baseline and discharge. All the variables showed impairment in the control group.

In conclusion, an exercise intervention using a pedal exerciser during the hospital stay of frail elderly patients with an AECOPD improves muscle strength, balance, and exercise capacity.     

Balance dysfunction in adults with haemophilia

Summary. The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under‐explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.     

Comparison of the effectiveness of isokinetic vs isometric therapeutic exercise in patients with osteoarthritis of knee

IntroductionOsteoarthritis is a chronic joint disease; isometric exercise leads to the development of mechanical work and isokinetic exercise leads to better joint mobility.ObjectivesTo compare the effectiveness of isometric versus isokinetic therapeutic exercises in patients with knee osteoarthritis.Material and methodsQuasiexperimental study in a population of 45 to 75 year old patients with a diagnosis of knee osteoarthritis. Group 1 (experimental) was put under isokinetic exercises and group 2 (control) under isometric exercises. The sample size was of 33 patients per group; the allocation to the experimentation or control group was nonrandom, but stratified by degrees of knee osteoarthritis. The effectiveness of the exercise was measured in three dimensions: muscle strength, joint range and pain. The intervention lasted eight weeks and the physical activity was carried out every third day. The statistical analysis included averages, standard deviation, percentage, Chi square test, z test for two populations, t test for two independent populations and twin t test.ResultsThe analysis of muscle strength comparing the categories independently demonstrates differences at 8 weeks; 33.3% of the isokinetic exercise is in the normal category and 15.2% in the isometric exercise (p= 0.04). There was not difference of joint range between groups, despite finding a stage I range in 100.0% of the isokinetic group and 97.0% in the isometric (p> 0.05) group. Pain was milder in the isokinetic exercise group at 8 weeks (p= 0.01)ConclusionsIsokinetic exercises have a greater effectiveness than isometric exercises for muscle strength and pain in patients with knee osteoarthritis. However, other studies with randomized designs are needed.     

Naturalistic Assessment of Everyday Memory Performance Among Older Adults

Background/Study Context: Indirect evidence suggests that concerns over the impressions made on others (self-presentational concerns) may be associated with balance-related outcomes in older adults, but no empirical evidence exists to support this speculation. The present study examined the relationship between self-presentational concerns (social anxiety, social physique anxiety, and self-presentational efficacy) and functional mobility, accounting for age, balance confidence, falls, and muscle strength.

Methods: Healthy women (60 years or older; N = 187) completed measures of self-presentational concerns, balance confidence, and fall history, and performed the timed up and go (TUG) test and a test of leg strength. Bivariate correlations were conducted. A hierarchical regression predicted TUG duration from the three self-presentational concerns, controlling for age, balance confidence, falls, and muscle strength to examine the unique variance in TUG duration explained by self-presentational concerns.

Results: Self-presentational efficacy was a significant predictor of TUG duration over and above that of age, balance confidence, falls, and muscle strength. The results also showed significant correlations between social anxiety and self-presentational efficacy and TUG duration, between all three self-presentational concerns and balance confidence, and between social physique anxiety and self-presentational efficacy and falls.

Conclusions: Research is needed to examine the causal relationship between these outcomes. Investigating self-presentational concerns in older women may provide novel ways to impact balance-related outcomes in this population. Practical implications for clinicians are discussed, as the social and physical environment may influence self-presentational concerns in this population and subsequently impact assessment and treatment outcomes.     

Jumping From a Chair is a More Sensitive Measure of Power Performance In Older Adults Than Chair Rising

Background/Study Context: The study estimates the reliability of peak velocity and peak power during chair rising and chair jumping tests and their ability to discriminate between different age and physical activity level groups.

Methods: Physically active and sedentary individuals (N = 262) of different ages (young: 22.9 ± 2.0 years, range: 21–25 years; older: 63.1 ± 1.8 years, range: 61–65 years) performed, in random order, chair rising and chair jumping tests on a force plate. Randomly selected young subjects performed both tests repeatedly on two different occasions separated by 1 week. From the sitting position with the arms crossed on the chest, they either stand up completely (chair rising test), or jump as high as possible (chair jumping test).

Results: The test-retest reliability of peak power and peak velocity during chair rising as well as chair jumping was excellent, with high intraclass correlation coefficients (ICCs; .90–.98) and low standard error of measurement (SEM; 7.0–9.1%). Post hoc analysis revealed significant differences in peak power and peak velocity between the sedentary and physically active young and older subjects. However, greater coefficients of variation for both parameters were found for chair jumping than chair rising (21.1–40.2% vs. 11.0–15.2%). Additionaly, there were moderate correlations of peak power and peak velocity between chair rising and chair jumping (r = .42–.49). There were greater within- and between-group differences in peak force and peak power and a steeper increase in their values during the initial phase of chair jumping than chair rising.

Conclusion: Both chair rising and chair jumping tests provide reliable data and are valid indicators of lower body power in young and older adults. However, jumping from a chair is a more sensitive measure of strength and power performance than chair rising.     

Evaluation of Rewind Yoga on Physical Function Outcomes in Older Adults: A Preliminary Study

Yoga is growing in popularity and has the potential to improve strength, flexibility, mobility, and balance in older adults. However, few yoga programs tailored to the unique needs of older adults exist. Rewind Yoga? was created to address this gap and a pilot study was conducted to evaluate the effectiveness of the program on physical function parameters. Healthy, older adults (n = 16) residing in a retirement community (55 and older) enrolled in a study examining the effect of Rewind Yoga? on strength, flexibility, dynamic balance, and endurance as measured by the Senior Fitness Test. A single group design (n = 14) with three repeated measures (baseline, 6 weeks, and 12 weeks) was used. Results from repeated measures analysis of variance indicated significant (P < 0.05) improvements in all measures of the Senior Fitness Test at 6 and 12 weeks. Rewind Yoga? appears to improve flexibility, strength, dynamic balance, and muscular endurance in older adults.     

Skeletal Muscle Fat and Its Association With Physical Function in Rheumatoid Arthritis

Objective

To characterize skeletal muscle fat (SMF), intermuscular adipose tissue (IMAT), and subcutaneous adipose tissue (SAT) in individuals with rheumatoid arthritis (RA), and assess the associations between these fat depots and physical function and physical activity.

Methods

In a cross‐sectional analysis from an RA cohort, SMF, IMAT, and SAT were measured using computed tomography imaging of the midthigh cross‐sectional region. Physical function was measured using the Health Assessment Questionnaire (HAQ) and a battery of performance‐based tests that included quadriceps muscle strength, gait speed, repeated chair‐stands, stair ascent, and single‐leg stance. Physical activity was assessed using an activity monitor. Associations between SMF, IMAT, and SAT and physical function and activity were assessed by multiple linear regression models adjusted for potential confounders such as age, sex, body mass index (BMI), muscle area, and muscle strength.

Results

Sixty subjects with RA (82% female, mean ± SD age 59 ± 10 years, mean ± SD BMI 31.79 ± 7.16 kg/m²) were included. In the adjusted models, lower SMF was associated with greater gait speed, single‐leg stance, quadriceps strength, and physical activity, and less disability (R²Δ range 0.06–0.25; P < 0.05), whereas IMAT was not associated with physical function or physical activity and SAT was negatively associated with disability (HAQ) (R²Δ = 0.13; P < 0.05) and weakly but positively associated with muscle strength (R²Δ = 0.023; P < 0.05).

Conclusion

Fat infiltration within the muscle seems to independently contribute to low physical function and physical activity, contrary to IMAT or SAT accumulation. Longitudinal studies are necessary to confirm the impact of SMF on disability and health promotion in persons with RA.

     

Effective Exercise for the Prevention of Falls: A Systematic Review and Meta‐Analysis

OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. DESIGN: Systematic review with meta‐analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included. SETTING: Older people. PARTICIPANTS: General community and residential care. MEASUREMENTS: Fall rates. RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I²=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48–0.69, 68% of between‐study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program. CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention.     

The effect of progressive resistance training in rheumatoid arthritis. Increased strength without changes in energy balance or body composition

Objective. To demonstrate the feasibility of high-intensity progressive resistance training in rheumatoid arthritis (RA) patients compared with healthy control subjects. Methods. Eight subjects with RA, 8 healthy young subjects, and 8 healthy elderly subjects underwent 12 weeks of high-intensity progressive resistance training, while 6 elderly subjects performed warm-up exercises only. Fitness, body composition, energy expenditure, function, disease activity, pain, and fatigue were measured at baseline and followup. Results. All 3 training groups demonstrated similar improvements in strength compared with the change among control subjects (RA group 57% [P < 0.0005], young exercise group 44% [P < 0.01], elderly exercise group 36% [P < 0.05]). Subjects with RA had no change in the number of painful or swollen joints but had significant reductions in self-reported pain score (21% [P < 0.05]) and fatigue score (38% [P = 0.06]), improved 50-foot walking times (mean ± SD 10.4 ± 2.2 seconds versus 8.3 ± 1.5 seconds [P < 0.005]), and improved balance and gait scores (48.9 ± 3.8 versus 50.4 ± 2.0 [P = 0.07]). Conclusion. High-intensity strength training is feasible and safe in selected patients with well-controlled RA and leads to significant improvements in strength, pain, and fatigue without exacerbating disease activity or joint pain.     

Changes in Functional Status After Aquatic Exercise in Adults with Type 2 Diabetes and Arthritis: A Pilot Study

Background: Arthritis is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and presents a barrier to participating in regular land-based physical activity.

Aim: To examine the effects of a 12-week community-based aquatic exercise program for overweight older adults (≥55 years of age) with T2DM and lower body arthritis.

Methods: For this quasi-experimental study, participants completed an exercise specialist-led program consisting of 60-min, twice/week, of aquatic activities at intensities that increased at 4-week increments from 40% to 65% of heart rate reserve for a total of 12 weeks. Clinical and functional measures were completed at baseline and after 12 weeks.

Results: Thirty participants completed baseline measures. Overall, half were female, mean (standard deviation = SD) age 67.7 (7.0) years, A1c = 6.7 (1.3)%, BMI = 35.9 (8.6) kg/m², average daily steps = 4207 (5504). Actual mean heart rate responses during aquatic exercise sessions were at 85%, 90%, and 85% of what was prescribed at weeks 4, 8, and 12, respectively. After 12 weeks, improvements were found for 6-min walking distance (+16.6, SD 43.4 m; p = .05), sit-to-stand repetitions (+1.0, SD 2.0; p = .01), and BMI (?0.2, SD 0.6 kg/m²; p = .04)

Conclusion: This pilot study showed that an aquatic program produced functional improvements among overweight older adults with T2DM and arthritis.     

Muscle performance and fatigue in compensated chronic liver disease

Abstract

Background: A common and debilitating symptom in patients with chronic liver disease is fatigue (CLD). Muscle dysfunction has been suggested to be a key mechanism of fatigue in CLD.

Objective: We aimed to evaluate fatigue and the potential association with muscle performance and physical activity in outpatients with CLD.

Methods: Two-hundred seventy outpatients with CLD were included, (52?±?15 years, mean?±?SD; 151 females) with autoimmune hepatitis (n?=?49), primary biliary cholangitis (n?=?45), primary sclerosing cholangitis (n?=?46), chronic hepatitis B (n?=?57) or C (n?=?73). Patients with a Child-Pugh >6 were excluded. The questionnaire Fatigue Impact Scale (FIS) was used to evaluate fatigue, and physical activity was evaluated through a self-reported level of physical activity. Muscle function was assessed with four muscle tests, walking speed, handgrip strength, standing heel-rise test (SHT) and ‘Timed Up and Go’ test (TUG).

Results: The median total FIS score was 30 (40% had FIS > 40, considered high-fatigue). Diminished muscle performance was observed in the SHT (% of predicted value: 53?±?26%) and with maximum grip strength (85?±?20%). The FIS score was significantly different between groups of CLDs (p?=?.004). In multivariate analysis the TUG (p?=?.001), SHT (p?=?.005), antidepressants (p?p?=?.001) were associated with fatigue (R²?=?29%). Subjects with higher levels of physical activity had lower FIS (p?Conclusions: In patients with CLD, fatigue was associated with low muscle performance and reduced level of physical activity, which could be a potential therapeutic target.     

Impact of a five-month detraining period on the functional fitness and physical activity levels on active older people

PurposeThis research was aimed at evaluating the effects of a five-month detraining period on the functional fitness level of a group of non-institutionalized and active older adults after taking part in a multi-component training program. A secondary aim was to determine how usual physical activity (PA) levels vary due to cessation of the program.MethodsWe tested sixty-five older people (mean age: 77.1 ± 6.2; 83% women) during the final week of an 8-month multi-component training program and during the first week after its resumption (five months later). We used the senior fitness test and the Minnesota Questionnaire to assess their functional fitness and their PA levels respectively.ResultsWe observed a significant worsening of lower-limb strength (p = 0.008), shoulder range of motion (p = 0.004), and dynamic balance (p < 0.001) once the detraining period was completed. There was a slight downward trend in the remaining functional fitness dimensions, and there were significant differences when comparing the amount of PA estimated at pre-detraining and post-detraining (5155 ± 2258 vs 3937 ± 2087 MET-min·wk⁻¹; p < 0.001). Older adults classified as very active showed a non-significant trend to smaller decreases in functional fitness once the detraining period was over, in comparison with those considered active.ConclusionsActive older people who regularly participated in a multicomponent training program showed a significant reduction in their strength, range of motion, and dynamic balance levels after a five-month detraining period. Self-reported PA decreased significantly during this time frame. Effective strategies are needed to increase PA levels in older people when systematic training programs are temporarily interrupted.     

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.     

Comparison of a static,independent balance protocol and the National Institute on Aging balance protocol on stability and risk of falling in the elderly

Falls by the elderly are preceded by muscle weakness and deteriorated sensory input. The aim of this study was to compare the effectiveness of an independent static balance (ISB) protocol with the National Institute on Aging (NIA) supervised protocol for improving balance. Sixteen participants (age 88.6 ± 4.3 year) were randomly placed in the ISB or NIA group. Pre- and posttests included fall risk (FR), overall stability (OS), anterior/posterior index (API), and medial and lateral index (MLI). Training consisted of 20 min, 2 × weeks for 12 weeks. The NIA group demonstrated greater improvement in all variables compared to the ISB group except for FR; however, there were no significant differences (p > 0.05) between the groups among any dependent variable. Static balance exercises conducted independently led to similar improvements in balance and FR reduction as the highly supervised NIA protocol. Balance can be improved independently without close supervision thus allowing personnel to tend to other patients.