Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Anabela Correia Martins, Daniela Guia, Marina Saraiva, Telmo Pereira, Anabela Correia Martins, Daniela Guia, Marina Saraiva, Telmo Pereira

Abstract

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.

Keywords: Exergames; falls; healthy ageing; older adults; “modified” Otago Exercise Program.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Instructions on the space required to perform exercise; (B) Instructions on how to fix the sensor; (C) Exercise instructions; (D) Mini-game 1; (E) Mini-game 2; (F) Mini-game 3 (Source: [26]).
Figure 2
Figure 2
Functional ability scores in the control group and the intervention group at baseline and post intervention. (a): Handgrip Strength; (b): 4 Stage Balance Test “Modified”; (c): Step Test; (d): 30s Sit-To-Stand; (e) Timed Up and Go.
Figure 2
Figure 2
Functional ability scores in the control group and the intervention group at baseline and post intervention. (a): Handgrip Strength; (b): 4 Stage Balance Test “Modified”; (c): Step Test; (d): 30s Sit-To-Stand; (e) Timed Up and Go.
Figure 3
Figure 3
(a): Self-Efficacy for exercise and (b): social participation scores in the control group and the intervention group at baseline and post intervention. PAPM: Activities and Participation Profile related to Mobility.

References

    1. World Health Organization (WHO) Global Strategy and Action Plan on Ageing and Health. World Health Organization; Geneva, Switzerland: 2017. [(accessed on 6 June 2019)]. Available online: .
    1. Ho S.C., Woo J., Yuen Y.K., Sham A., Chan S.G. Predictors of Mobility Decline: The Hong Kong Old-old Study. J. Gerontol. Med. Sci. 1997;52:356–362. doi: 10.1093/gerona/52A.6.M356.
    1. Buchman A.S., Wilson Ã.R.S., Boyle P.A., Tang Ã.Y., Fleischman D.A., Bennett D.A. Physical Activity and Leg Strength Predict Decline in Mobility. J. Am. Geriatr. Soc. 2007;55:1618–1623. doi: 10.1111/j.1532-5415.2007.01359.x.
    1. Verghese J., Levalley Ã.A., Hall Ã.C.B., Katz Ã.M.J. Epidemiology of Gait Disorders in Community-Residing Older Adults. J. Am. Geriatr. Soc. 2006;54:255–261. doi: 10.1111/j.1532-5415.2005.00580.x.
    1. Sturnieks L., St George R., Lord S. Balance disorders in the elderly. Neurophysiol. Clin. Neurophysiol. 2008;38:467–478. doi: 10.1016/j.neucli.2008.09.001.
    1. World Health Organization (WHO) WHO Global Report on Falls Prevention in Older Age. World Health Organization; Lyon, France: 2007.
    1. Coutinho E.D.S.F., Silva S.D. Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos. Cad. Saude Publica. 2002;18:1359–1366. doi: 10.1590/S0102-311X2002000500029.
    1. Gardner M.M., Robertson M.C., Campbell A.J. Exercise in preventing falls and fall related injuries in older people: A review of randomised controlled trials. Br. J. Sports Med. 2000;34:7–17. doi: 10.1136/bjsm.34.1.7.
    1. Sachetti A., Vidmar M.F., Marinho M., Schneider R.H., Wibelinger M. Risco de quedas em idosos com osteoporose. Rev. Bras. Ciências Saúde. 2010;24:22–26.
    1. World Health Organization (WHO) Health Literacy: The Solid Facts. WHO; Copenhagen, Denmark: 2013.
    1. Kerrigan D.C., Lee L.W., Collins J.J., Riley P.O., Lipsitz L.A. Reduced Hip Extension during Walking: Healthy Elderly and Fallers versus Young Adults. Arch. Phys. Med. Rehabil. 2001;82:26–30. doi: 10.1053/apmr.2001.18584.
    1. Kwon I.S., Oldaker S., Schrager M., Talbot L.A., Fozard J.L., Metter E.J. Relationship between Muscle Strength and the Time Taken to Complete a Standardized Walk-Turn-Walk Test. J. Gerontol. Biol. Sci. 2001;56:398–404. doi: 10.1093/gerona/56.9.B398.
    1. Ahmadiahangar A., Javadian Y., Babaei M., Heidari B., Hosseini S., Aminzadeh M. The role of quadriceps muscle strength in the development of falls in the elderly people, a cross-sectional study. Chiropr. Man. Ther. 2018;26:31. doi: 10.1186/s12998-018-0195-x.
    1. American Geriatrics Society/British Geriatrics Society (AGS/BGS) Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J. Am. Geriatr. Soc. 2011;59:148–157. doi: 10.1111/j.1532-5415.2010.03234.x.
    1. National Institute for Health and Care Excellence (NICE) Falls: Assessment and Prevention of Falls in Older People. NICE; London, UK: 2013. NICE Clinical Guideline 161.
    1. Gillespie L.D., Robertson M.C., Gillespie W.J. Interventions for preventing falls in older people living in the community. Cochrane Database Syst. Rev. 2009;2:CD007146.
    1. Silva T.O., Freitas R.S.D.F., Monteiro M.R., Borges S.D.M. Avaliação da capacidade física e quedas em idosos ativos e sedentários da comunidade. Rev. Bras. Clin. Med. 2010;8:392–398.
    1. Matsudo S.M., Keihan V., Matsudo R., Barros L. Atividade física e envelhecimento: Aspectos epidemiológicos. Rev. Bras. Med. Esporte. 2001;7:2–13. doi: 10.1590/S1517-86922001000100002.
    1. Bjerk M., Brovold T., Skelton D.A., Bergland A. A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: Study protocol for a randomised controlled trial. BMC Health Serv. Res. 2017;17:559. doi: 10.1186/s12913-017-2516-5.
    1. Accident Compensation Corporation (ACC) Otago Exercise Programme to Prevent Falls in Older Adults: A Home-Based, Individually Tailored Strength and Balance Retraining Programme. University of Otago; Dunedin, New Zealand: 2007.
    1. Patel N.N. The Effects of Otago Exercise Programme for Fall Prevention in Elderly People. Int. J. Physiother. 2015;2:633–639. doi: 10.15621/ijphy/2015/v2i4/67743.
    1. Alhasan H., Hood V., Mainwaring F. The effect of visual biofeedback on balance in elderly population: A systematic review. Clin. Interv. Aging. 2017;12:487–497. doi: 10.2147/CIA.S127023.
    1. Silva J., Moreira D., Madureira J., Pereira E., Dias A., Sousa I. A thecnological solution for supporting fall prevention exercises at the physiotherapy clinic; Proceedings of the IEEE International Symposium on Medical Measurements & Applications; Rome, Italy. 11–13 June 2018.
    1. Sousa I., Silva J., Moreira D., Madureira J., Tonelo C., Dias A. FallSensing—Tecnological solution for fall risk screening and falls prevention; Proceedings of the EU Falls Festival; Manchester, UK. 2–3 July 2018.
    1. Silva J., Oliveira E., Moreira D., Nunes F., Caic M., Madureira J., Pereira E. Design and evaluation of fall prevention multiplayer game for senior care centers; Proceedings of the International Conference on Entertainment Computing (IFIP-ICEC’18); Poznan, Poland. 17–20 September 2018.
    1. Silva J., Oliveira E., Moreira D., Nunes F., Caic M., Madureira J., Pereira E. Design and Evaluation of a Fall Prevention Multiplayer Game for Senior Care Centres. In: Clua E., Roque L., Lugmayr A., Tuomi P., editors. Entertainment Computing—ICEC 2018. Springer; Cham, Switzerland: 2018. Lecture Notes in Computer Science.
    1. Rantanen T., Volpato S., Ferrucci L., Heikkinen E., Fried L.P., Guralnik J.M. Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism. J. Am. Geriatr. Soc. 2003;51:636–641. doi: 10.1034/j.1600-0579.2003.00207.x.
    1. Aadahl M., Beyer N., Linneberg A., Thuesen B.H., Jørgensen T. Grip strength and lower limb extension power in 19–72-year-old Danish men and women: The Health 2006 study. BMJ Open. 2011;1:e000192. doi: 10.1136/bmjopen-2011-000192.
    1. Bastiaanse L.P., Hilgenkamp T.I.M., Echteld M.A., Evenhuis H.M. Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities. Res. Dev. Disabil. 2012;33:2004–2012. doi: 10.1016/j.ridd.2012.06.002.
    1. Campbell T.M., Vallis L.A. Predicting fat-freemass index and sarcopenia in assisted-living older adults. Age. 2014;36:9674. doi: 10.1007/s11357-014-9674-8.
    1. Martins A.C., Moreira J., Silva C., Silva J., Tonelo C., Baltazar D., Rocha C., Pereira T., Sousa I. Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study. JMIR Res. Protoc. 2018;7:e10304. doi: 10.2196/10304.
    1. Jones C.J., Rikli R.E., Beam W.C. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res. Q. Exerc. Sport. 1999;70:113–119. doi: 10.1080/02701367.1999.10608028.
    1. Cadore E.L., Rodríguez-Mañas 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;16:105–114. doi: 10.1089/rej.2012.1397.
    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. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Siggeirsdóttir K., Jónsson B.Y., Jónsson H., Iwarsson S. The timed ‘Up & Go’ is dependent on chair type. Clin. Rehabil. 2002;16:609–616.
    1. Rehabilitation Measures Database. [(accessed on 22 February 2019)]; Available online: .
    1. Beauchet O., Fantino B., Allali G., Muir S., Montero-Odasso M., Annweiler C. Timed Up and Go test and risk of falls in older adults: A systematic review. J. Nutr. Health Aging. 2011;15:933–938. doi: 10.1007/s12603-011-0062-0.
    1. Hill K.D., Bernhardt J., McGann A.M., Maltese D., Berkovits D. A New Test of Dynamic Standing Balance for Stroke Patients: Reliability, Validity and Comparison with Healthy Elderly. Physiother. Can. 1996;48:257–262. doi: 10.3138/ptc.48.4.257.
    1. Grimmer-Somers K., Hillier S., Young A., Sutton M., Lizarondo L. CAHE Neurological Outcomes Calculator User Manual: Monitoring Patient Status over Time Using Common Neurological Outcome Measures. University of South Australia—Centre for Allied Health Evidence; Adelaide, Australia: 2009.
    1. Isles R., Choy N., Steer M., Nitz J. Normal values of balance tests in women aged 20–80. J. Am. Geriatr. Soc. 2004;52:1367–1372. doi: 10.1111/j.1532-5415.2004.52370.x.
    1. Rossiter-Fornoff J.E., Wolf S.L., Wolfson L.I., Buchner D.M. A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J. Gerontol. A Biol. Sci. Med. Sci. 1995;50:M291–M297. doi: 10.1093/gerona/50A.6.M291.
    1. Thomas J.C., Odonkor C., Griffith L., Holt N., Percac-Lima S., Leveille S., Ni P., Latham N.K., Jette A.M., Bean J.F. Reconceptualizing balance: Attributes associated with balance performance. Exp. Gerontol. 2014;57:218–223. doi: 10.1016/j.exger.2014.06.012.
    1. Martins A.C., Silva C., Moreira J., Rocha C., Gonçalves A. Escala de autoeficácia para o exercício: Validação para a população portuguesa. In: Pocinho R., Ferreira S.M., Anjos V.N., editors. Conversas de Psicologia e do Envelhecimento Ativo. Associação Portuguesa Conversas de Psicologia; Coimbra, Portugal: 2017. pp. 126–141.
    1. Martins A.C. Development and initial validation of the Activities and Participation Profile related to Mobility (APPM) BMC Health Serv. Res. 2016;16:78–79.
    1. Schoene D., Lord S.R., Delbaere K., Severino C., Davies T.A., Smith S.T. A Randomized Controlled Pilot Study of Home-Based Step Training in Older People Using Videogame Technology. PLoS ONE. 2013;8:e57734. doi: 10.1371/journal.pone.0057734.
    1. Martins A.C., Silva J., Santos A., Madureira J., Alcobia J., Ferreira L., Mendes P., Tonelo C., Silva C., Baltazar D., et al. Case-based study of metrics derived from instrumented fall risk assessment tests. Gerontechnology. 2016;15:106. doi: 10.20944/preprints201608.0132.v1.
    1. Rose D.J., Jones C.J., Lucchese N. Predicting the Probability of Falls in Community-Residing Older Adults Using the 8-Foot Up-and-Go: A New Measure of Functional Mobility. J. Aging Phys. Act. 2002;10:466–475. doi: 10.1123/japa.10.4.466.
    1. Lanziotti S., Gomes V., Máximo L.S., Marcos J., Dias D., Dias R.C. Comparação entre diferentes pontos de corte na classificação do perfil de fragilidade de idosos comunitários. Geriatr. Gerontol. 2011;5:130–135.
    1. Murphy M.A., Olson S.L., Protas E.J., Overby A.R. Screening for Falls in Community-Dwelling Elderly. J. Aging Phys. Activ. 2003;11:66–80. doi: 10.1123/japa.11.1.66.
    1. Shubert T.E., Schrodt L.A., Mercer V.S., Busby-Whitehead J., Giuliani C.A. Are scores on balance screening tests associated with mobility in older adults? J. Geriatr. Phys. Ther. 2006;29:35–39. doi: 10.1519/00139143-200604000-00007.
    1. Center for Disease Control and Prevention ASSESSMENT: 30-Second Chair Stand. [(accessed on 18 December 2019)];2017 Available online: .
    1. Lim J., Cho J.J., Kim J., Kim Y., Yoon B.C. Design of virtual reality training program for prevention of falling in the elderly: A pilot study on complex versus balance exercises. Eur. J. Integr. Med. 2017;15:64–67. doi: 10.1016/j.eujim.2017.09.008.
    1. Yoo H.N., Chung E., Lee B.H. The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women. J. Phys. Ther. Sci. 2013;25:797–801. doi: 10.1589/jpts.25.797.
    1. Davis J.C., Hsu C.L., Cheung W., Brasher P.M.A., Li L.C., Khan K.M., Sykes J., Skelton D.A., Liu-Ambrose T. Can the Otago falls prevention program be delivered by video? A feasibility study. BMJ Open Sport Exerc. Med. 2016;2:e000059. doi: 10.1136/bmjsem-2015-000059.
    1. Fu A.S., Gao K.L., Tung A.K., Tsang W.W., Kwan M.M. Effectiveness of Exergaming Training in Reducing Risk and Incidence of Falls in Frail Older Adults with a History of Falls. Arch. Phys. Med. Rehabil. 2015;96:2096–2102. doi: 10.1016/j.apmr.2015.08.427.
    1. Duque G., Boersma D., Loza-Diaz G., Hassan S., Suarez H., Geisinger D., Suriyaarachchi P., Sharma A., Demontiero O. Effects of balance training using a virtual-reality system in older fallers. Clin. Interv. Aging. 2013;8:257–263. doi: 10.2147/CIA.S41453.
    1. Rodrigues E.V., Valderramas S.R., Rossetin L.L., Gomes A.R.S. Effects of Video Game Training on the Musculoskeletal Function of Older Adults. A Systematic Review and Meta-analysis. Top. Geriatr. Rehabil. 2014;30:238–245. doi: 10.1097/TGR.0000000000000040.
    1. Prata M.G., Scheicher M.E. Effects of strength and balance training on the mobility, fear of falling and grip strength of elderly female fallers. J. Bodyw. Mov. Ther. 2015;19:646–650. doi: 10.1016/j.jbmt.2014.11.013.
    1. Park E.C., Kim S.G., Lee C.W. The effects of virtual reality game exercise on balance and gait of the elderly. J. Phys. Ther. Sci. 2015;27:1157–1159. doi: 10.1589/jpts.27.1157.
    1. Thibaud M., Bloch F., Tournoux-Facon C., Brèque C., Rigaud A.S., Dugué B., Kemoun G. Impact of physical activity and sedentary behaviour on fall risks in older people: A systematic review and meta-analysis of observational studies. Eur. Rev. Aging Phys. Activ. 2012;9:5–15. doi: 10.1007/s11556-011-0081-1.
    1. Molina K.I., Ricci N.A., Moraes S.A., Perracini M.R. Virtual reality using games for improving physical functioning in older adults: A systematic review. J. Neuroeng. Rehabil. 2014;11:156. doi: 10.1186/1743-0003-11-156.
    1. Li J., Erdt M., Chen L., Cao Y., Lee S. The Social Effects of Exergames on Older Adults: Systematic Review and Metric Analysis. J. Med. Internet Res. 2018;20:e10486. doi: 10.2196/10486.
    1. Jessup J.V., Horne C., Vishen R.K., Wheeler D. Effects of exercise on bone density, balance, and self-efficacy in older women. Biol. Res. Nurs. 2003;4:171–180. doi: 10.1177/1099800402239628.
    1. McAuley E., Mihalko S.L., Rosengren K. Self-efficacy and balance correlates of fear of falling in the elderly. J. Aging Phys. Activ. 1997;5:329–340. doi: 10.1123/japa.5.4.329.
    1. Martins A.C., Santos C., Silva C., Baltazar D., Moreira J., Tavares N. Does modified Otago Exercise Program improves balance in older people? A systematic review. Prev. Med. Rep. 2018;11:231–239. doi: 10.1016/j.pmedr.2018.06.015.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren