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

1. Melinda M Gardner,
2. M Clare Robertson,
3. A John Campbell

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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Rethinking individual and community fall prevention strategies

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

1. A. John Campbell and
2. M. Clare Robertson

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

1. 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

1. Catherine Sherrington PhD,
2. Julie C. Whitney MSc,
3. Stephen R. Lord DSc,
4. Robert D. Herbert PhD,
5. Robert G. Cumming PhD,
6. Jacqueline C. T. Close MD

Article first published online: 31 OCT 2008

DOI: 10.1111/j.1532-5415.2008.02014.x

© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society

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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Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

Abstract  / Keywords:

• fall avoidance efficacy;
• falls;
• nursing;
• older adults;
• physical fitness;
• Tai Chi exercise

Aim.  This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme.

Background.  Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people.

Methods.  A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77·8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests.

Results.  At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0·001) and extensors (P < 0·01), and improved flexibility (P < 0·01) and mobility (P < 0·001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0·62. The experimental group reported significantly more confidence in fall avoidance than did the control group.

Conclusion.  The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.

Quelle:   http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2005.03480.x/abstract?globalMessage=0

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Vibrationstraining / Fitvibe: Personal-Vibrationstraining

Vibrationstraining / Fitvibe: Personal-Vibrationstraining: Personal-Vibrationstraining:  Kombinieren Sie Vibrationstraining mit Übungen zur Verbesserung der Mobilität (beispielsweise aus dem Power-Y...

Post-Run Yoga Flexibility Routine

Nach dem Laufen sollst Du ruhen und unbedingt etwas für die Flexibilität tun:

Video von: Post-Run Yoga Flexibility Routine   /   http://www.youtube.com/watch?v=HBLVMR4Asi8&feature=relmfu

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