Exercise Based on Proprioceptive Neuromuscular Facilitation in Older Individuals

Physical Functioning Adaptations Following a Resisted Functional Exercise Program Based on the Proprioceptive Neuromuscular Facilitation Concept in Older Individuals: a Randomized Clinical Trial

The goal of this clinical trial was to determine whether an intervention using resisted sit-to-stand and walking exercises with Proprioceptive Neuromuscular Facilitation (PNF) techniques improved gait and sit-to-stand in older individuals with poor functional capacity compared to a control group that performed the same activities, but without manual resistance. The main questions it aimed to answer were:

Did an exercise program based on the PNF concept improve functional capacity and strength performance?

Was there a difference between an exercise program with or without PNF techniques on functional capacity and strength in older adults?

Researchers compared the effects of an exercise program based on the PNF concept to a similar exercise training without manual resistance on functional capacity and strength performance.

Participants participated in an intervention using resisted sit-to-stand and walking exercises with or without PNF and performed functional capacity and strength tests at the beginning and end of the intervention.

Study Overview

• Status: Completed
• Conditions: Dynapenia; Functional Disability; Sarcopenia in Elderly
• Intervention / Treatment: Other: Proprioceptive Neuromuscular Facilitation; Other: Physical exercise without proprioceptive neuromuscular facilitation control group

Detailed Description

The proposal consisted of investigating an exercise intervention based on the Proprioceptive Neuromuscular Facilitation concept (PFNG), compared to a control group (CG), which performed the same exercises as PNFG under a therapist's supervision, but without resistance imposed by the therapist's hands as in PFNG, in older individuals.

Before data collection, individuals participated in a familiarization procedure for each test. Each specific test was conducted on the same equipment with identical participant/equipment positioning. Functional assessment and intervention were conducted at the participants' residences.

The CG intervention consisted of the same activities carried out in the PNFG during Stages 1 and 2, for the same amount of minutes, sessions, and weeks. However, the CG intervention did not include specific techniques and basic principles (i.e., approximation and optimal resistance) and procedures of the PNF concept. The activities were instructed and supervised by a trained professional through verbal commands. The professional was in a stand-by assistant position to prevent accidents. Each intervention lasted 30 minutes and took place twice a week, for 4 weeks, totaling 8 meetings. The interventions were supervised by researchers blinded to pre-intervention assessment results and randomly assigned for both PNF and control groups. The researchers responsible for the interventions were physical therapists with basic IPNFA® (International Proprioceptive Neuromuscular Facilitation Association) instruction.

• Study Type: Interventional
• Enrollment (Actual): 26
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • RS
    • Porto Alegre, RS, Brazil, 90690-200
      • Escola de Educação Física Fisioterapia e Dança - UFRGS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Short Physical Performance Battery score lower than 10 points.

Exclusion Criteria:

• Neurodegenerative diseases;
• Illnesses contraindicating exercise (e.g., uncontrolled arrhythmias, acute myocardial infarction);
• Unstable medical condition.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Proprioceptive Neuromuscular Facilitation Group; The Proprioceptive Neuromuscular Facilitation group (PNFG) intervention consisted of applying PNF concept exercises and techniques related to facilitating sitting and walking, carried out by a therapist with basic IPNFA® (International Proprioceptive Neuromuscular Facilitation Association) instruction. The PNF intervention was divided into two stages: Stage 1: which consisted of facilitating stability and controlled mobility of the initial position and phases 1, 2, 3, of the sit-up. At the initial position, we applied PNF stabilizing reversals technique for 2 minutes, to stimulate stability in the upright sitting position. In phase 1, we applied PNF to stimulate controlled mobility of the anterior inclination of the erect trunk. In Phase 2, to improve the concentric and eccentric control of lower limb extensor muscles and, in Phase 3 to improve the stability in an upright position again. Stage 2: consists of facilitating activities related to gait.	Other: Proprioceptive Neuromuscular Facilitation; The following basic principles and procedures were emphasized when applying the techniques: manual contact, resistance, approximation, verbal commands, and therapist's body mechanics. During stages 1 and 2 of the intervention, the amount of PNF optimal resistance used was necessary to maintain a stable and safe position, with good body alignment, in a manner that produced coordinated movements to generate appropriate motor learning.
Active Comparator: Physical exercise without proprioceptive neuromuscular facilitation control group; The physical exercise without proprioceptive neuromuscular facilitation control group (CG) Intervention consisted of the same activities carried out in the proprioceptive neuromuscular facilitation group (PNFG) during Stages 1 and 2, during the same amount of minutes, sessions, and weeks; however, CG intervention did not include specific techniques and basic principles (i.e. approximation and optimal resistance) and procedures of the PNF concept. The activities were instructed and supervised by a trained professional through verbal command. The professional was at stand-by assistant position to prevent accidents.	Other: Physical exercise without proprioceptive neuromuscular facilitation control group; The physical exercise without proprioceptive neuromuscular facilitation control group (CG) intervention consisted of the same activities carried out in the proprioceptive neuromuscular facilitation (PNF) group during Stages 1 and 2, during the same amount of minutes, sessions, and weeks; however, CG intervention did not include specific techniques and basic principles (i.e. approximation and optimal resistance) and procedures of the PNF concept. The activities were instructed and supervised by a trained professional through verbal command. The professional was at stand-by assistant position to prevent accidents.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Short Physical Performance Battery	Short Physical Performance Battery (SPPB) includes usual walking speed over 4 meters, balance, and five times sit-to-stand. The sum of the three individual categorical scores yielded the final SPPB score, which ranged from 0 (worst) to 12 (best).	Baseline and immediately after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Timed Up and Go	The Timed Up and Go test consists of measuring the time required to perform the task of standing from a chair, walking 3 meters, turning, going back, and sitting down on the chair.	Baseline and immediately after the intervention
Handgrip strength	Handgrip strength is measured using a hand dynamometer (Jamar Hydraulic Hand Dynamometer). The dynamometer is squeezed twice with each hand while the participant is seated. The upper arm is positioned close to the body with the elbow at a 90° angle. The higher score is used, provided the difference does not exceed 10%; otherwise, a third measurement is taken.	Baseline and immediately after the intervention
Gait speed	Gait speed is assessed through a 4-meter walking test. Participants are asked to walk 4 meters at their usual speed on a horizontal walkway.	Baseline and immediately after the intervention
Static balance	Static balance is assessed through 10-second hold parallel feet, semi-tandem, and tandem positions. Participants progress to the hardest test only if they succeed in the easiest.	Baseline and immediately after the intervention
Sit-To-Stand	The sit-to-stand test consists of the time spent standing from a chair 5 times.	Baseline and immediately after the intervention

Collaborators and Investigators

• Sponsor: Federal University of Rio Grande do Sul

Publications and helpful links

General Publications

• Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. 2013 Apr;16(2):105-14. doi: 10.1089/rej.2012.1397.
• Gunning E, Uszynski MK. Effectiveness of the Proprioceptive Neuromuscular Facilitation Method on Gait Parameters in Patients With Stroke: A Systematic Review. Arch Phys Med Rehabil. 2019 May;100(5):980-986. doi: 10.1016/j.apmr.2018.11.020. Epub 2018 Dec 22.
• Alexandre de Assis IS, Luvizutto GJ, Bruno ACM, Sande de Souza LAP. The Proprioceptive Neuromuscular Facilitation Concept in Parkinson Disease: A Systematic Review and Meta-Analysis. J Chiropr Med. 2020 Sep;19(3):181-187. doi: 10.1016/j.jcm.2020.07.003. Epub 2020 Dec 15.

Study record dates

Study Major Dates

• Study Start (Actual): March 23, 2023
• Primary Completion (Actual): June 3, 2024
• Study Completion (Actual): June 3, 2024

Study Registration Dates

• First Submitted: November 11, 2024
• First Submitted That Met QC Criteria: November 13, 2024
• First Posted (Actual): November 15, 2024

Study Record Updates

• Last Update Posted (Estimated): November 19, 2024
• Last Update Submitted That Met QC Criteria: November 16, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: Balance; Gait; Functionality; Frailty; Proprioceptive Neuromuscular Facilitation; Sit-Stand
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Sarcopenia
• Other Study ID Numbers: URioGrandePNF

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Time Frame: After the end of the study, no end date for sharing IPD was set.
• IPD Sharing Access Criteria: Researchers affiliated with recognized research institutions, with a research project approved by an ethics committee for the protection of human subjects, will have access to the following data: the study protocol, statistical analysis plan, informed consent form, clinical study report, and analytic code. They can request access by emailing the principal investigator with all necessary information. After review, a data table will be sent.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No