Montag, 31. Dezember 2012

Ein gesundes und glückliches Neues Jahr 2013!!

Video von: http://www.youtube.com/watch?v=iZHwMVhJ81g

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Sonntag, 25. November 2012

Krafttraining mit Älteren

Ein Trainingseinsteiger mit >60 Jahren beginnt sein Training nicht mit einer schweren am Boden liegenden Olympiahantel oder einem Maximalkrafttraining.

Zur Trainingsintensität und zur Trainingsplanung lässt sich folgende Herangehensweise festhalten (BUCHBAUER / STEININGER, 2004, S.7):

Trainingsintensitäten-, und -inhalte im präventiven Krafttraining (eigene Darstellung)

Trainingsintensitäten, übergeordnete Trainingsinhalte und Ziele im präventiven Krafttraining

a) Aktivierung, Propriozeption / Sensomotorik, intermuskuläre Koordination

b) Lokales Muskelausdauertraining

c) Vergrößerung des Muskelquerschnitts (Muskelaufbau)

d) Steigerung neuromuskulärer Kraftqualitäten

e) Entwicklung vielfältiger und situationsunabhängiger Kraftqualitäten

Struktur und Inhalte des Trainings sind immer abhängig vom Ausgangsniveau und werden entsprechend ausgewählt und aufgebaut.

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Donnerstag, 4. Oktober 2012

Fall Prevention in Residential Care

A Cluster, Randomized, Controlled Trial

Ngaire Kerse MBChB, PhD,
Meg Butler MPH,
Elizabeth Robinson MSc,
Maree Todd FRACP, MBChB

Article first published online: 30 MAR 2004

DOI: 10.1111/j.1532-5415.2004.52157.x

ABSTRACT:

Keywords:

fall prevention;
residential care;
cluster randomized controlled trial

Objectives: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents.

Design: Cluster, randomized, controlled trial.

Setting: Fourteen randomly selected residential care homes in Auckland, New Zealand.

Participants: All older residents (n=628, 95% participation rate).

Intervention: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks.

Measurements: Number of residents sustaining a fall, falls, and injurious-falls incidence rates.

Results: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06–1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.

Conclusion: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care.

Quelle: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2004.52157.x/abstract

Full Text / pdf:

Kerse, N., Butler, M., Robinson, E. and Todd, M. (2004), Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial. Journal of the American Geriatrics Society, 52: 524–531. doi: 10.1111/j.1532-5415.2004.52157.x

http://ot.creighton.edu/community/EBLP/Question3/Kerse%202004%20Fall%20Prevention%20in%20Residential%20Care.pdf

Online im internet - Zugriff vom 04.10.2012

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Therapeutic benefits of Tai Chi exercise

Research review

Kuramoto AM.

Source

University of Wisconsin-Milwaukee College of Nursing, WI, USA. alicek@uwm.edu

Abstract

The majority of studies on Tai Chi conducted between 1996 and 2004 had focused on health and well being of Tai Chi exercise for senior adults. The results show that Tai Chi may lead to improved balance, reduced fear of falling, increased strength, increased functional mobility, greater flexibility, and increased psychological well-being, sleep enhancement for sleep disturbed elderly individuals, and increased cardio functioning. Wang, Collet, and Lau did a systematic review on Tai Chi research and found some limitations or biases existing in some of the studies, and it was difficult to draw firm conclusions about the benefits reported.

Therefore, more well-designed studies are needed in the future. There need to be studies on the effects on younger and middle-aged people. More longitudinal studies are needed, since time is an important factor of physical and psychological interventions. Studies on the effects of Tai Chi on the immune system and bone loss reduction are still very exploratory and will be especially useful for arthritis patients and others with immune disorders.

Future studies should investigate outcomes associated with Tai Chi training as a function of different instructional techniques, different Tai Chi styles, different diagnostic groups, and different age groups. It is not yet clear which of the components in Tai Chi makes the exercise form especially effective for seniors.

Tai Chi exercise is a relatively "low tech" approach to preventing disability and maintaining physical performance in older adults. The positive effects of Tai Chi may be due solely to its relaxing, meditative aspects.

The current data suggest that Tai Chi can influence older individuals' functioning and well being and provide some appreciation for why this exercise form has been practiced by older Chinese for more than 3 centuries.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/17163086

Full Text / pdf / Link - online im internet - Zugriff vom 04.10.12:

http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/issues/wmj_v105n7/kuramoto.pdf

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The efficacy of a specific balance-strategy training programme

The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial

Nitz, Jennifer C. and Low Choy, Nancy (2004) The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial. Age and Ageing, 33 1: 52-58.

ABSTRACT:

Background: older people participate in exercise programmesto reduce the risk of falls but no study has investigated aspecific balance strategy training intervention presented ina workstation format for small groups.

Objective: to determine whether a specific balance strategytraining programmeme delivered in a workstation format was superiorto a community based exercise class programme for reducing falls.

Design: a randomised controlled trial model.

Setting: Neurological Disorders, Ageing and Balance Clinic,Department of Physiotherapy, The University of Queensland.

Subjects: 73 males and females over 60 years, living independentlyin the community and who had fallen in the previous year wererecruited.

Methods: all subjects received a falls risk education bookletand completed an incident calendar for the duration of the study.Treatment sessions were once a week for 10 weeks. Subject assessmentbefore and after intervention and at 3 months follow-up includednumber of falls, co-morbidities, medications, community servicesand activity level, functional motor ability, clinical and laboratorybalance measures and fear of falling.

Results: all participants significantly reduced the number offalls (P < 0.000). The specific balance strategy interventiongroup showed significantly more improvement in functional measuresthan the control group (P = 0.034). Separate group analysesindicated significantly improved performance in functional motorability and most clinical balance measures for the balance group(P < 0.04). The control group only improved in TUG and TUGcog.

Conclusions: the results provide evidence that all participantsachieved a significant reduction in falls. Specific balancestrategy training using workstations is superior to traditionalexercise classes for improving function and balance.

Quelle: http://espace.uq.edu.au/view/UQ:68941

Full Text / Link / pdf - online im internet - Zugriff vom 04.10.2012:

The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial

Nitz, Jennifer C. and Low Choy, Nancy (2004) The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial. Age and Ageing, 33 1: 52-58.

http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/noajc/03_04/jul04/NitzBalanceTraining.pdf

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Dienstag, 2. Oktober 2012

Evidence for a Non-linear Relationship between Leg Strength and Gait Speed

Abstract

Although the relationship between strength and physical performance in older adults is probably non-linear, few empirical studies have demonstrated that this is so.

In a population-based sample of adults aged 60–96 years (n = 409), leg strength was measured in four muscle groups (knee extensor, knee flexor, ankle plantar flexor, ankle dorsiflexor) of both legs using an isokinetic dynamometer. A leg strength score was calculated as the sum of the four strength measurements in the right leg. Usual gait speed was measured over a 15.2 metre course.

With a linear model, leg strength explained 17% of the variance in gait speed. Non–linear models (quadratic and inverse) explained significantly more variance (22%).

The nature of the non-linear relationship was that, in stronger subjects, there was no association between strength and gait speed, while in weaker subjects, there was an association. Body weight and age also explained significant amounts of variance in gait speed, while sex and height did not.

The results supported the hypothesis of a non-linear relationship between leg strength and gait speed that is similar for older men and women.

This finding represents a mechanism for how small changes in physiological capacity may have substantial effects on performance in frail adults, while large changes in capacity have little or no effect in healthy adults.

Quelle: http://ageing.oxfordjournals.org/content/25/5/386.short

Full Text / pdf von: Evidence for a Non-linear Relationship between Leg Strength and Gait Speed - online im internet - Zugriff vom 02.10.2012:

http://ageing.oxfordjournals.org/content/25/5/386.full.pdf

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Identification of elderly fallers by muscle strength measures

Abstract
The original publication is available at http://link.springer.de/link/service/journals/00421/index.htm. For efficient prevention of falls among older adults, individuals at a high risk of falling need to be identified. In this study, we searched for muscle strength measures that best identified those individuals who would fall after a gait perturbation and those who recovered their balance. Seventeen healthy older adults performed a range of muscle strength tests. We measured maximum and rate of development of ankle plantar flexion moment, knee extension moment and whole leg push-off force, as well as maximum jump height and hand grip strength. Subsequently, their capacity to regain balance after tripping over an obstacle was determined experimentally. Seven of the participants were classified as fallers based on the tripping outcome. Maximum isometric push-off force in a leg press apparatus was the best measure to identify the fallers, as cross-validation of a discriminant model with this variable resulted in the best classification (86% sensitivity and 90% specificity). Jump height and hand grip strength were strongly correlated to leg press force (r = 0.82 and 0.59, respectively) and can also be used to identify fallers, although with slightly lower specificity. These results indicate that whole leg extension strength is associated with the ability to prevent a fall after a gait perturbation and might be used to identify the elderly at risk of falling.

Quelle: http://en.scientificcommons.org/34613507

Full Text / pdf von: Identification of elderly fallers by muscle strength measures - online im internet - Zugriff vom 02.102012:

http://www.biomedsearch.com/attachments/00/18/07/17/18071745/421_2007_Article_613.pdf

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Tai Chi and Fall Reductions in Older Adults

A Randomized Controlled Trial

Abstract

Background. The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons.

Methods. This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up.

Results. At the end of the 6-month intervention, significantly fewer falls (n = 38 vs 73; p =.007), lower proportions of fallers (28% vs 46%; p =.01), and fewer injurious falls (7% vs 18%; p =.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p <.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group.

Conclusions. A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

Quelle: http://biomedgerontology.oxfordjournals.org/content/60/2/187.short

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Exercise and injury prevention in older people

D. A. Skelton,
N. Beyer

Article first published online: 14 JAN 2003

^ABSTRACT

Keywords:

exercise;
balance;
falls;
risk of falling;
fall prevention;
injury prevention;
aged.

This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries.

Falls and injury may lead to a spiral of inactivity and decline that take older people close to or below the critical “thresholds” of performance necessary for everyday activities.

Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk factors for falls modifiable with tailored exercise.

Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention.

It is clear that the target population must be at risk or already fallers, they must be “not too fit” and “not too frail”.

Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly.

In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective.

There are, however, research questions that still need answering – whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries.

This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.

^{Quelle: http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0838.2003.00300.x/abstract}

Exercise and injury prevention in older people -D. A. Skelton,N. Beyer

^{Full Text / pdf: http://www.laterlifetraining.co.uk/wp-content/uploads/2011/12/ExInjPrevScandJMedSciSports2003.pdf}

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Falls prevention over 2 years

Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.

Abstract

BACKGROUND:

after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial.

OBJECTIVE:

we aimed to assess the effectiveness of the programme over 2 years.

SUBJECTS:

women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. METHODS: falls and compliance to the exercise programme were monitored for 2 years.

RESULTS: 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49-0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42-0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group.

CONCLUSIONS:

falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period.

Quelle: http://ageing.oxfordjournals.org/content/28/6/513.short

Full Text / pdf - Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Autoren:

online im internet - Zugriff vom 02.10.2012 - http://ageing.oxfordjournals.org/content/28/6/513.full.pdf

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Physical Activity and Public Health in Older Adults

Recommendation from the American College of Sports Medicine and the American Heart Association

Autores: Miriam E. Nelson, W. Jack Rejeski, Steven N. Blair
Localización: Medicine & Science in Sports & exercise: Official Journal of the American College of Sports Medicine, ISSN 0195-9131, Vol. 39, Nº. 8, 2007, págs. 1435-1445
Resumen
- Objective: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
  
  Participants: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
  
  Evidence: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.
  Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
  
  Summary: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

Quelle: http://dialnet.unirioja.es/servlet/articulo?codigo=2888508

Full Text / pdf - online im internet - Zugriff vom 02.10.2012 - http://www.lorenzinifoundation.org/ActiveDoctors2011/Letteratura%5CPA%20guidelines%20for%20older%20adults_2007.pdf

Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association

http://www.lorenzinifoundation.org/ActiveDoctors2011/Letteratura%5CPA%20guidelines%20for%20older%20adults_2007.pdf

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Sonntag, 30. September 2012

Balance and strength training in older adults

Intervention gains and Tai Chi maintenance

Wolfson L, Whipple R, Derby C, Judge J, King M, Amerman P, Schmidt J, Smyers D.

Source

Department of Neurology, University of Connecticut School of Medicine, Hartford, USA.

Abstract

OBJECTIVE:

To determine the effect on balance and strength of 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains.

DESIGN:

Randomized control intervention. Four groups in 2 x 2 design: Control, Balance, Strength, Balance + Strength, using blinded testers.

SETTING:

Exercise and balance laboratory at University of Connecticut Health Center.

PARTICIPANTS:

Subjects were 110 healthy community dwellers (mean age 80) who were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions.

INTERVENTIONS:

Short-term training (3 months) occurred 3 times/week (45 minutes Balance and Strength, 90 minutes Balance + Strength). Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback. Strengthening consisted of lower extremity weight-lifting. All subjects than received long-term group Tai Chi instruction (6 months, 1 hour, 1 time/week).

MEASUREMENTS:

Losses of balance during Sensory Organization Testing (LOB), single stance time (SST), voluntary limits of stability (FBOS), summed isokinetic torque of eight lower extremity movements (ISOK), and usual gait velocity (GVU).

RESULTS AND CONCLUSIONS:

Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger: LOB = -2.0 +/- 0.3 (adjusted paired differences, P < .005 ANOVA); SST = 7.0 +/- 1.2 sec; and FBOS = 9.0 +/- 2.0% of foot length (P < .05). Strengthening increased ISOK by 1.1 +/- 0.1 Nm kg-1 (P < .005). There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/8617896

Full Text / pdf - Balance and strength training in older adults: intervention gains and Tai Chi maintenance. von: Wolfson L, Whipple R, Derby C, Judge J, King M, Amerman P, Schmidt J, Smyers D. - online im internet - Zugriff 30.09.2012:

http://www.white-lotus.com/Ken%20Documents/Balance%20and%20Strength%20Training%20in%20Older%20Adults%20Study.pdf

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Exercise in preventing falls and fall related injuries in older people

A review of randomised controlled trials

Abstract

Objective—To assess the effectiveness of exercise programmes in preventing falls (and/or lowering the risk of falls and fall related injuries) in older people.

Design—A review of controlled clinical trials designed with the aim of lowering the risk of falling and/or fall injuries through an exercise only intervention or an intervention that included an exercise component

Main outcome measures—Falls, fall related injuries, time between falls, costs, cost effectiveness.

Subjects—A total of 4933 men and women aged 60 years and older.

Results—Eleven trials meeting the criteria for inclusion were reviewed. Eight of these trials had separate exercise interventions, and three used interventions with an exercise programme component. Five trials showed a significant reduction in the rate of falls or the risk of falling in the intervention group.

Conclusions—Exercise is effective in lowering falls risk in selected groups and should form part of falls prevention programmes. Lowering fall related injuries will reduce health care costs but there is little available information on the costs associated with programme replication or the cost effectiveness of exercise programmes aimed at preventing falls in older people.

Take home message

Many different risk factors contribute to falls, but muscle weakness and poor balance underlie most falls. Strength training against resistance and dynamic balance retraining improve both strength and balance and in randomised controlled trials have been shown to decrease the risk of falls. Exercise programmes that are individually tailored and target those at high risk may be the most effective.

Falls in older people are an important but often overlooked problem. A third of people aged 65 years and older fall each year and half of those in their eighties fall at least once a year.

Falls are the most common cause of injury in people aged 65 years and older and may result in institutionalisation and death

Muscle weakness and poor balance have been well established as risk factors for falls in prospective cohort studies

Appropriately targeted exercise programmes of sufficient intensity will increase and improve muscle strength, balance, and cardiovascular fitness in older people

Exercises to improve strength and balance have therefore been central to most fall prevention programmes.

The purpose of this review is to examine the evidence for the value of exercise in preventing falls in older people.

Quelle und Full Text: http://bjsportmed.com/content/34/1/7.full

Full Text / pdf - online im internet - Zugriff 30.09.2012 - GARDNER, M.; ROBERTSON, M.C.; CAMPBELL, J.A.: Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials:

http://www.stopfalls.org/files/preventingfalls.pdf

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Donnerstag, 27. September 2012

Rethinking individual and community fall prevention strategies

Rethinking individual and community fall prevention strategies: a meta-regression comparing single and multifactorial interventions

A. John Campbell and
M. Clare Robertson

Department of Medical and Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand

Address correspondence to: A. john Campbell. Email: john.campbell@stonebow.otago.ac.nz

Abstract

Background guidelines recommend that fall prevention programmes for older people include multifactorial interventions.

Objective we aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fall prevention.

Methods we searched the literature for trials of interventions aimed at preventing falls. We included trials if they met the following criteria: (i) participants were randomly allocated to intervention and control groups, (ii) all participants were aged 65 years or older, (iii) the majority lived independently in the community, (iv) fall events were recorded prospectively using a diary or calendar during the entire trial and monitored at least monthly, (v) follow up was for 12 months or longer, (vi) at least 70% of participants completed the trial, (vii) all falls during the trial for at least 50 participants were included in the analysis, and (viii) a relative rate ratio with 95% CI comparing the number of falls in the intervention and control groups was reported. We calculated a pooled rate ratio separately for trials testing multifactorial and single interventions and compared their overall efficacy using meta-regression.

Results meta-regression showed that single interventions were as effective in reducing falls as interventions with multiple components (pooled rate ratios 0.77, 95% CI 0.67–0.89 and 0.78, 0.68–0.89 respectively).

Conclusion multifactorial fall prevention interventions are effective for individual patients. However, for community programmes for populations at risk, targeted single interventions are as effective as multifactorial interventions, may be more acceptable and cost effective.

Quelle: http://ageing.oxfordjournals.org/content/36/6/656.full

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Fall Prevention Programs for the Elderly: How Effective Are They?

Nursing Research: January/February 2002 - Volume 51 - Issue 1 - pp 1-8

Features

A Meta-Analysis of Fall Prevention Programs for the Elderly: How Effective Are They?

Hill-Westmoreland, Elizabeth E.; Soeken, Karen; Spellbring, Ann Marie

Abstract

Background: Although fall prevention studies for the elderly have been reported, there is a paucity of work summarizing the effectiveness of these interventions.

Objectives: The research question that guided this study was: What are the effects of fall prevention programs on the proportion of falls in the elderly?

Method: Meta-analysis was employed to summarize findings of intervention studies of fall prevention in the elderly involving a comparison group and a quantifiable outcome. Studies were reviewed by two of the authors with the eligibility criteria in mind. Studies were then coded and an inter-rater reliability check was performed.

Results: The overall mean weighted effect size for the 12 studies included in the meta-analysis was .0779 (Z = 5.03, p < .001). For fall prevention intervention types, exercise alone had a mean weighted effect size of .0220 (Z = .5303, p > .5), exercise and risk modification had a mean weighted effect size of .0687 (Z = 3.41, p < .001), and comprehensive risk assessment intervention studies had an effect size of .1231 (Z = 3.97, p < .001). The mean weighted effect size size for community-based studies was .0972 (Z = 5.37, p < .001) and for institution-based studies was .0237 (Z = .7822, p = .22). Time to outcome measure analyses revealed that the mean weighted effect size for studies measuring proportion of falls at 12 months was .0905 (Z = 5.43, p < .001), and those measuring at four months or less was -.0972 (Z = -.005, p > .50).

Conclusions: The results of this meta-analysis indicate that there was a 4% decrease in the rate of falls for individuals who were in the treatment groups receiving various fall prevention interventions. Additional intervention studies need to be conducted in the elderly population with a goal of preventing falls.

Quelle Link:

http://journals.lww.com/nursingresearchonline/Abstract/2002/01000/A_Meta_Analysis_of_Fall_Prevention_Programs_for.2.aspx

Direktlink zum pdf (kostenfrei):

http://stallgeriatrics.com/falls/Article-MetaAnalysisofFallPreventionPrograms%28NursingResearch2002%29.pdf

In dieser o.g. Untersuchung scheint es allerdings etwa querbeet zu gehen - teilweise werden Interventionen verglichen, die sich eigentlich nicht vergleichen lassen, da sowohl der Aufbau wie auch die Intervention nicht unbedingt vergleichbar sind.

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Effects of a fall prevention program including exercise on mobility and falls

Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities.

Jensen J, Nyberg L, Rosendahl E, Gustafson Y, Lundin-Olsson L.

Source: Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Sweden. jane.jensen@physiother.umu.se

Abstract

BACKGROUND AND AIMS:

Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling.

METHODS:

187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering.

RESULTS:

At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. No association was found between improved mobility and reduced risk of falling.

CONCLUSIONS:

Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/15575122

Den vollständigen Artikel finden Sie hier -Effects of fall prevention program . pdf-Link:

http://pure.ltu.se/portal/files/2228730/Artikel.pdf

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Effective Exercise for the Prevention of Falls

A Systematic Review and Meta-Analysis

Catherine Sherrington PhD,
Julie C. Whitney MSc,
Stephen R. Lord DSc,
Robert D. Herbert PhD,
Robert G. Cumming PhD,
Jacqueline C. T. Close MD

Article first published online: 31 OCT 2008

DOI: 10.1111/j.1532-5415.2008.02014.x

ABSTRACT

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 development and implementation of effective and cost-efficient strategies to prevent falls in older people is an urgent global health challenge. In developed countries, life expectancy for people aged 65 years old is approximately 17 years for men and 21 years for women. At least one-third of people aged 65 and older fall at least once annually,¹ and falls account for more than half of the injury-related hospitalizations for older people.² Fall rates in the general older population are reported to be 1.2 falls per person year.³

Falls in older people are not purely random events but can be predicted by assessing a number of risk factors.^4,5 Some of these risk factors (e.g., reduced muscle strength and impaired balance and gait) can be modified using exercise, whereas others (e.g., poor vision, psychoactive medication use) require different intervention approaches. Exercise can be used as a stand-alone falls prevention intervention or as a component of a multifaceted program. Multifaceted interventions can prevent falls in the general community, in those at greater risk of falls, and in residential care facilities.^4,6

Many trials have sought to establish the specific effect of exercise on fall rates, but a large proportion of these trials have been underpowered. The best way to interpret these trials may be to pool their data in a meta-analysis, but trials of the effects of exercise on fall rates vary in their quality, have been conducted on a range of populations, and employ exercise programs that differ greatly in their aims and content. Meta-analysis should therefore involve exploration of whether these factors “explain” (are associated with) estimates of the effect of exercise programs.^7,8

A Cochrane review of fall prevention strategies⁶ conducted separate meta-analyses on different forms of exercise and concluded that some exercise programs can prevent falls in community dwellers (e.g., home exercise program of balance and strength training, a Tai Chi group program) but that others are unlikely to be beneficial (brisk walking in women with an upper limb fracture in the previous 2 years) or require further investigation (untargeted group-based exercise interventions and individual lower-limb strength training).

A limitation to this approach is that it combines programs that may be different (e.g., group programs that are of low and high intensity) and separates programs that share key features (e.g., balance training).

This study sought to establish the effect of exercise on fall rates, with a major aim of explaining between-trial variability. Meta-regression methods were used to investigate whether particular features of study populations, exercise programs, and study design were associated with the size of estimates of effects of exercise on fall rates.

Quelle: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full?globalMessage=0

Das vollständige pdf finden Sie hier:

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/pdf

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Exercise in the Prevention of Falls in Older People

A Systematic Literature Review Examining the Rationale and the Evidence

Authors: Carter N.D; Kannus P.; Khan K.M.

Source: Sports Medicine, Volume 31, Number 6, 1 June 2001 , pp. 427-438(12)

Abstract:

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars.

Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults. These changes coupled with age-related changes in muscle and bone are likely to contribute to an increased risk of falls in this population.

The integrated rehabilitation-based model of fall risk factors reveals multiple sites for interventions that may reverse fall risk factors. Regular exercise may be one way of preventing falls and fall-related fractures.

The evidence for this contention comes from a variety of sources. On the basis of 9 randomised controlled studies conducted since 1996, exercise appears to be a useful tool in fall prevention in older adults, significantly reducing the incidence of falls compared with control groups.

However, current limitations such as inconsistencies in the measurement of key dependent and independent variables do not, at present, permit a meta-analysis of intervention trials. Further investigation, using trials designed with the current limitations in mind, is necessary to establish the optimum exercise programme to maximise fall prevention in older adults.

Quelle: http://www.ingentaconnect.com/content/adis/smd/2001/00000031/00000006/art00003

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A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes

A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes

McMurdo MET, Millar AM, Daly F

Gerontology 2000;46:83–87 (DOI: 10.1159/000022139)

Abstract:

Background:

Falls are a major cause of morbidity in old age. A small number of fall prevention trials in cognitively intact community-dwelling older people have been effective. This study set out to examine the preventability of falls in older people living in institutional care.

Objective:

To evaluate the effectiveness of falls risk factor assessment/modification and seated balance exercise training in reducing falls among elderly people living in residential care. Methods: 133 residents with a mean age of 84± (SD) 6.8 years were allocated at random by home to receive either a 6-month falls risk factor assessment/modification and seated balance exercise training programme (n = 77) or 6 months of reminiscence therapy (n = 56). The risk factors targeted were postural hypotension, polypharmacy, visual acuity, and ambient lighting levels. Falls risk factor assessments and recommendation for modifications were performed at baseline in the intervention group and assessments repeated at 6 months. Functional reach, reaction time, timed up-and- go, grip strength, spinal flexibility, and Philadelphia Geriatric Centre Morale Scale and Mini-Mental State Examination scores were determined at baseline and at 6 months by a ‘blind’ observer. Falls and fractures were then monitored in both groups during a 7- to 12-month falls-monitoring follow-up period.

Results:

Only 90 of 133 (67.7%) residents completed the 6-month intervention period, and 84 (63.2%) completed the 7- to 12-month falls-monitoring follow-up period. Both prevalence of postural hypotension (p = 0.0005) and poor visual acuity (p = 0.04) were reduced in the intervention group. There was no difference between the groups in the number of falls sustained, the risk of falling [odds ratio 0.45 (95% CI 0.19–1.14)], or in the risk of recurrent falling [odds ratio 1.07 (95% CI 0.40–2.97)]. No significant differences were found between the groups with regard to change in other outcome measures.

Conclusions:

The high drop-out rate reduced the power of this study to detect any effect of the interventions used. It is possible that either the exercises were not sufficiently vigorous or that to improve balance exercises must be performed standing. Further research is required to identify effective fall prevention strategies for elderly people in residential settings.

Copyright © 2000 S. Karger AG, Basel

Quelle: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=22139&ProduktNr=225842

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