Academic journal article Physical Therapy

Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial

Academic journal article Physical Therapy

Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial

Article excerpt

Balance is defined as the ability to maintain the projection of the body's center of mass within limits of the base of support, as in standing or sitting, or in transit to a new base of support, as in walking. (1) Balance control is complex and multifactorial. Physiological changes related to aging include reduction in muscle strength, (2) joint range of motion, reaction time, and changes in sensory systems. (3,4) These factors, combined with pathology affecting these systems, potentially have negative effects on older people's balance control and may lead to balance dysfunction of varying severity.

Management of older people's balance dysfunction plays a key role in fall prevention. Impaired balance and reaction time, as well as loss of lower-limb muscle strength, have been identified as important risk factors for falls in older people. (5,6) These factors have been shown to be amenable to interventions that can be carried out in the community setting. (7)

Published trials have shown that exercise interventions with balance and muscle strengthening components are effective in reducing falls (8-10) and in improving physiological and functional performance in older people. (11) Most published studies evaluating effectiveness of exercise programs have either targeted "healthy, active older people," (12,13) without clear classification, or selected samples of older people with moderate to severe levels of balance dysfunction. These samples include frail older people with multiple functional limitations, (14,15) older people residing in institutions, (16-17) and older people with specific conditions such as stroke (18,19) or Parkinson disease, (20) a history of falls or multiple falls, (21, 22) or established risk factors for falls. (23-26)

Falls often are used as a trigger to review risk factors (including balance) to determine whether interventions are needed. (27) However, there has been recent interest in approaches to identifying problems contributing to falls before balance impairment becomes more marked and a fall occurs. (28-30) Curb and colleagues described a need for tests to discriminate performance on the "gradient of functioning at the upper end of the functional spectrum." (31(p738)) Using responsive tests of balance performance to identify mild levels of balance impairment could meet this need and identify people who without intervention would be likely to progress to becoming a "faller." Furthermore, from a health promotion and prevention perspective, an exercise intervention introduced when balance dysfunction has recently developed or is of a mild level of severity may be more effective, less expensive, or both, (32) than implementing intervention at a late stage, when more advanced balance dysfunction or falls are occurring.

There is a lack of research into older people with mild levels of balance dysfunction, and the effectiveness of exercise interventions in this group is unknown. Therefore, the current study aimed to investigate the effectiveness of a personalized, home-based exercise program in reversing older people's mild balance dysfunction. The hypothesis tested in this study was that a home exercise program is effective in improving balance performance of older people with identified mild balance dysfunction.

Method

This study was a randomized controlled trial. Clinical and laboratory measures of balance, mobility, gait, and muscle strength were assessed at baseline and at a 6-month reassessment. Participants in the intervention group underwent a personalized, home-based exercise program prescribed by a physical therapist, and participants in the control group continued with their usual activities.

Participants

The sample consisted of 225 community-dwelling men and women aged 65 years and over. Recruitment started in February 2006 and was completed in September 2007. Participants were recruited from metropolitan Melbourne, Australia, by advertising in newspapers and newsletters, as well as through presentations by researchers to community groups of older people. …

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