Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Vilai Kuptniratsaikul, Rungnirand Praditsuwan, Prasert Assantachai, Teerada Ploypetch, Suthipol Udompunturak, Julaporn Pooliam, Vilai Kuptniratsaikul, Rungnirand Praditsuwan, Prasert Assantachai, Teerada Ploypetch, Suthipol Udompunturak, Julaporn Pooliam

Abstract

Objective: To study the effectiveness of simply-performed balancing exercises in fall prevention.

Design: Pre- and post-trial.

Setting: University hospital from January 2009 to May 2010.

Participants: Elderly with falls in the previous year.

Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet.

Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods.

Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P<0.001) except for functional reach in the frequent fall group. Most subjects (72%-79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling ≥3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98).

Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.

Keywords: balancing training; elderly; exercise; fall prevention; frequent fall.

Figures

Figure 1
Figure 1
Balancing abilities including timed up and go test, chair stand, functional reach, and Berg balance scale based on compliance with exercise.
Figure 2
Figure 2
Quality of life score (SF-36) of 104 participants compared between baseline and 1-year after.

References

    1. Downton JH. Falls. In: Tallis R, Fillit H, Brocklehurst JC, editors. Geriatric Medicine and Gerontology. 5th ed. Edinburgh, Scotland: Churchill Livingstone; 1998. pp. 1359–1370.
    1. Formiga F, Navarro M, Duaso E, et al. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone. 2008;43:941–944.
    1. Berry SD, Miller RR. Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep. 2008;6:149–154.
    1. Hektoen LF, Aas E, Lurås H. Cost-effectiveness in fall prevention for older women. Scand J Public Health. 2009;37:584–589.
    1. Kannus P, Uusi-Rasi K, Palvanen M, Parkkari J. Non-pharmacological means to prevent fractures among older adults. Ann Med. 2005;37:303–310.
    1. Baker MK, Atlantis E, Fiatarone Singh MA. Multi-modal exercise programs for older adults. Age Ageing. 2007;36:375–381.
    1. Skelton DA, Beyer N. Exercise and injury prevention in older people. Scand J Med Sci Sports. 2003;13:77–85.
    1. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;2:CD007146.
    1. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. Does a home based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic analyses of falls prevention interventions. Br J Sports Med. 2010;44:80–89.
    1. Petridou ET, Manti EG, Ntinapogias AG, Negri E, Szczerbinska K. What works better for community-dwelling older people at risk to fall?: a meta-analysis of multifactorial versus physical exercise-alone interventions. J Aging Health. 2009;21:713–729.
    1. Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FIC-SIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA. 1995;273:1341–1347.
    1. Lajoie Y. Effect of computerized feedback postural training on posture and attentional demands in older adults. Aging Clin Exp Res. 2004;16:363–368.
    1. Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Phys Ther. 1993;73:254–262.
    1. Barr R, Macdonald H, Stewart A, et al. Association between vitamin D receptor gene polymorphisms, falls, balance and muscle power: results from two independent studies (APOSS and OPUS) Osteoporos Int. 2010;21:457–466.
    1. Clark RD, Lord SR, Webster IW. Clinical parameters associated with falls in an elderly population. Gerontology. 1993;39:117–123.
    1. Podsiadlo D, Richardson S. The timed “Up and Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–148.
    1. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–M94.
    1. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:M192–M197.
    1. Chou CY, Chien CW, Hsueh IP, et al. Developing a short form of the Berg Balance Scale for people with stroke. Phys Ther. 2006;86:195–204.
    1. Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:304–311.
    1. Kongsakon R, Silpakit C. Thai version of the medical outcome study 36 items short form health survey: an instrument for measuring clinical results in mental disorder patients. Rama Med J. 2000;23:8–19.
    1. Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil. 1996;77:1025–1029.
    1. Gillespie LD, Gillespie WJ, Cumming R, Lamb SE, Rowe BH. Interventions for preventing falls in the elderly. Cochrane Database Syst Rev. 2000;2:CD000340.
    1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2001;3:CD000340.
    1. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;4:CD000340.
    1. Howe TE, Rochester L, Jackson A, Banks PM, Blair VA. Exercise for improving balance in older people. Cochrane Database Syst Rev. 2007;4:CD004963.
    1. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234–2243.
    1. Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc. 2002;50:905–911.
    1. Jung YM, Shin DS, Chung KS, Lee SE. Health status and fall-related factors among older Korean women: implications for nurses. J Gerontol Nurs. 2007;33:12–20.
    1. Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA. 1989;261:2663–2668.
    1. Clough-Gorr KM, Erpen T, Gillmann G, et al. Preclinical disability as a risk factor for falls in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2008;63:314–320.
    1. Stalenhoef PA, Diederiks JP, Knottnerus JA, Kester AD, Crebolder HF. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol. 2002;55:1088–1094.
    1. Lin MR, Wolf SL, Hwang HF, Gong SY, Chen CY. A randomized, controlled trial of fall prevention programs and quality of life in older fallers. J Am Geriatr Soc. 2007;55:499–506.

Source: PubMed

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