Context: There is a paucity of information on well-designed exercise programs for the Primary Falls Prevention. Objective: This study aimed to evaluate a tailor-made exercise program for improving balance and balance-related fitness among older adults without history of falls but who were at risk of falling. Design, Setting, and Participants: A single-blind and randomized controlled trial for 61 older adults (age = 70 ± 3 years, males = 25%) with no history of falls but who were at risk of falling enrolled at the local senior center. Intervention: Participants were randomly allocated into three groups. An intervention group receiving a tailor-made Exercise for Balance Improvement Program (ExBP; n = 20), an active control group receiving the 8-form Yang-style Tai Chi (TC; n = 20), and a no-treatment concurrent control group (CON; n = 21). The ExBP was developed based on demographic and clinical characteristics of old adults as well as on the most reported deficits in balance and balance-related systems. The movements chosen in ExBP were those used in previous studies for older adults. The movements were integrated with considerations of movement specificity, movement complexity and organization, movement safety, feasibility and gracefulness, as well as the transfer of exercise learning. Modifications of these movements were made following experts and end-users’ evaluations. Training dosage was set at “90 minutes per session x 3 sessions per week x 16 weeks with an 8-week follow-up. Outcome Measurements: The primary outcome was a composite measure of balance capacities, including Fall Risk Test (FRT), Postural Stability Test (PST), Limits of Stability Test (LOS), and a modified Clinical Test of Sensory Organization and Balance (m-CTSIB). The secondary outcomes referred to those balance-related fitness including 30s Chair Stand Test (CS), Chair Sit-and-Reach Test (SR), 8ft Up and Go Test (UG), 2min Step Test (Step), Choice Stepping Response Time (CSRT), as well as Fear of Falling (FF). All the testing parameters were collected one week before the intervention (pre-test), at the end of 12th week (mid-test), at the end of 16th week (post-test), and at the end of 24th week (follow-up test). Analysis of variance with pre-test data as covariance and repeated measures analysis of variance were conducted to examine Group effect and Time effect, respectively. Results: All testing parameters in the ExBP group demonstrated an improvement trend from pre-test to post-test, especially in FRT, m-CTSIB, CS, SR, UG, and FF (p < .05). In comparison with the CON group at post-test, there were significant improvements in the ExBP group in FRT, m-CTSIB with compromised somatosensation, m-CTSIB with compromised vision and somatosensation, CS, UG, Step, and FES (p < .05), while the improvements at mid-test were only shown in UG and FF. There were no significant differences on any of the testing parameters between post-test and follow-up test. In addition, continuous improvements were shown in FRT, PST, m-CTSIB, SR, UG, CSRT, and FF during the follow-up period. In comparison with the TC group at mid-test, ExBP showed significantly more improvements in FRT, UG, Step and FF. Although without statistically significant group difference at post-test except in Step, improvements in FRT, PST in anterior-and-posterior direction, m-CTSIB with compromised somatosensation, m-CTSIB with compromised vision and somatosensation, SR, UG, Step, and CSRT were more pronounced in the ExBP group. The losses of training effect from post-test to follow-up test in ExBP was lower than the Tai Chi especially in FRT, m-CTSIB with compromised vision and somatosensation, Step, and CSRT. Conclusion: The ExBP can be applied as an effective exercise program for improving balance and balance-related fitness among older adults at risk of falling. In comparison with Tai Chi, training effects from ExBP occurred earlier and lasted longer.
|Date of Award||9 Jun 2015|
|Supervisor||Pak-Kwong CHUNG (Supervisor)|