Montag, 31. Dezember 2012
Samstag, 1. Dezember 2012
Alter aktiv gestalten – Was kann die Wissenschaft, was die Praxis leisten?
Fauja Singh, der mit 100 Jahren
älteste Marathonläufer, ist sicher ein Extrem. Aber: Es gibt zahlreiche
Ansatzpunkte, das körperliche, geistige und soziale Wohlbefinden auch
bis ins hohe Alter zu fördern. ........
Der Austausch von Praktikern und Wissenschaftlern ist für die Weiterentwicklung von Prävention und Gesundheitsförderung von zentraler Bedeutung. Dabei müssen natürlich beide Seiten vom Wissenstransfer (lokales Wissen versus wissenschaftliche Erkenntnisse und umgekehrt) profitieren, betonte die Direktorin der Bundeszentrale für gesundheitliche Aufklärung (BZgA), Prof. Elisabeth Pott, in ihrer Eröffnungsrede.
Genau diese Sichtweise liegt auch der vom Bundesministerium für Bildung und Forschung geförderten Kooperation für Nachhaltige Präventionsforschung (KNP) zugrunde: Jede Forschungseinrichtung muss mit einem Praxispartner interagieren.
Die diesjährige Jahrestagung „Lebensphase Alter gestalten – gesund und aktiv älter werden" wurde gemeinsam mit dem BZgA-Arbeitsschwerpunkt „gesund und aktiv älter werden" ausgerichtet. Im Zentrum standen die 14 KNP-Projekte für ältere Menschen sowie die Inhalte der BZgA-Regionalkonferenzen zum gesunden Altern.
Die rund 90 Teilnehmerinnen und Teilnehmer aus Wissenschaft, Praxis und Verwaltung hatten in mehreren Workshops die Gelegenheit einzelne Projekte näher kennen zu lernen, die Möglichkeiten und Barrieren von Prävention und Gesundheitsförderung zu diskutieren sowie sich über die Übertragbarkeit der Erkenntnisse auf andere Handlungsfelder auszutauschen.
Zahlreiche Referenten und Referentinnen betonten in ihren Vorträgen, dass es bei Prävention und Gesundheitsförderung nicht alleine um eine Verlängerung des Lebens gehe – die Lebenserwartung in den westlichen Industriestaaten unterscheide sich kaum. Vielmehr sei das Ziel, den Anteil des Lebens, der in Gesundheit verbracht wird, zu verlängern. In diesem Punkt unterscheiden sich die europäischen Staaten teilweise deutlich. Hier gibt es also noch Verbesserungspotenzial.
Quelle: http://www.bvpraevention.de/cms/index.asp?inst=bvpg&snr=8904
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Der Austausch von Praktikern und Wissenschaftlern ist für die Weiterentwicklung von Prävention und Gesundheitsförderung von zentraler Bedeutung. Dabei müssen natürlich beide Seiten vom Wissenstransfer (lokales Wissen versus wissenschaftliche Erkenntnisse und umgekehrt) profitieren, betonte die Direktorin der Bundeszentrale für gesundheitliche Aufklärung (BZgA), Prof. Elisabeth Pott, in ihrer Eröffnungsrede.
Genau diese Sichtweise liegt auch der vom Bundesministerium für Bildung und Forschung geförderten Kooperation für Nachhaltige Präventionsforschung (KNP) zugrunde: Jede Forschungseinrichtung muss mit einem Praxispartner interagieren.
Die diesjährige Jahrestagung „Lebensphase Alter gestalten – gesund und aktiv älter werden" wurde gemeinsam mit dem BZgA-Arbeitsschwerpunkt „gesund und aktiv älter werden" ausgerichtet. Im Zentrum standen die 14 KNP-Projekte für ältere Menschen sowie die Inhalte der BZgA-Regionalkonferenzen zum gesunden Altern.
Die rund 90 Teilnehmerinnen und Teilnehmer aus Wissenschaft, Praxis und Verwaltung hatten in mehreren Workshops die Gelegenheit einzelne Projekte näher kennen zu lernen, die Möglichkeiten und Barrieren von Prävention und Gesundheitsförderung zu diskutieren sowie sich über die Übertragbarkeit der Erkenntnisse auf andere Handlungsfelder auszutauschen.
Zahlreiche Referenten und Referentinnen betonten in ihren Vorträgen, dass es bei Prävention und Gesundheitsförderung nicht alleine um eine Verlängerung des Lebens gehe – die Lebenserwartung in den westlichen Industriestaaten unterscheide sich kaum. Vielmehr sei das Ziel, den Anteil des Lebens, der in Gesundheit verbracht wird, zu verlängern. In diesem Punkt unterscheiden sich die europäischen Staaten teilweise deutlich. Hier gibt es also noch Verbesserungspotenzial.
Quelle: http://www.bvpraevention.de/cms/index.asp?inst=bvpg&snr=8904
JÖRG LINDER AKTIV-TRAINING - www.aktiv-training.de
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Donnerstag, 4. Oktober 2012
Development of a Common Outcome Data Set for Fall Injury Prevention Trials
The Prevention of Falls Network Europe Consensus
Keywords:
- accidental falls;
- aged;
- fractures;
- consensus development;
- outcome measures
The
prevention of injury associated with falls in older people is a public
health target in many countries around the world. Although there is good
evidence that interventions such as multifactorial fall prevention and
individually prescribed exercise are effective in reducing falls, the
effect on serious injury rates is unclear.1,2
Historically, trials have not been adequately powered to detect injury
endpoints, and variations in case definition across trials have hindered
meta-analysis.1
It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in populations who are at a higher risk of injury.
Further research is required to determine whether fall-prevention interventions can reduce serious injuries.
It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in populations who are at a higher risk of injury.
Further research is required to determine whether fall-prevention interventions can reduce serious injuries.
Prevention
of Falls Network Europe (ProFaNE) is a collaborative project to reduce
the burden of fall injury in older people through excellence in research
and promotion of best practice (http://www.profane.eu.org).
The European Commission funds the network, which links clinicians,
members of the public, and researchers worldwide.
The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity, including clinical trials, comparative research, and prospective meta-analysis.
Work is being undertaken in a 4-year program. As a first step, the development of a common set of outcome definitions and measures for future trials or meta-analysis was considered.
The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity, including clinical trials, comparative research, and prospective meta-analysis.
Work is being undertaken in a 4-year program. As a first step, the development of a common set of outcome definitions and measures for future trials or meta-analysis was considered.
Quelle: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2005.53455.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true
JÖRG LINDER AKTIV-TRAINING - www.aktiv-training.de
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JÖRG LINDER AKTIV-TRAINING
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Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People
Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People
The decline in muscle strength and mass during aging1,2 has been linked to physical frailty, falls, functional decline, and impaired mobility in very elderly people3-5.
Although many factors, including chronic illness, a sedentary lifestyle, nutritional deficiencies, and aging itself, may contribute to muscle weakness and loss of skeletal-muscle mass in people of advanced age,6-10 currently only skeletal-muscle disuse11,12 and undernutrition13-15 are potentially preventable or reversible with targeted interventions.
Muscle dysfunction associated with malnutrition may improve with nutritional supplementation in younger patients16,17. Even in healthy elderly men, a multinutrient supplement augmented muscle hypertrophy, although not muscle strength, during a resistance training regimen similar to the one described here18.
We hypothesized that physical frailty is partially mediated by skeletal-muscle disuse and marginal nutritional intake, and should therefore be reduced by interventions designed to reverse these deficits.
Although many factors, including chronic illness, a sedentary lifestyle, nutritional deficiencies, and aging itself, may contribute to muscle weakness and loss of skeletal-muscle mass in people of advanced age,6-10 currently only skeletal-muscle disuse11,12 and undernutrition13-15 are potentially preventable or reversible with targeted interventions.
Muscle dysfunction associated with malnutrition may improve with nutritional supplementation in younger patients16,17. Even in healthy elderly men, a multinutrient supplement augmented muscle hypertrophy, although not muscle strength, during a resistance training regimen similar to the one described here18.
We hypothesized that physical frailty is partially mediated by skeletal-muscle disuse and marginal nutritional intake, and should therefore be reduced by interventions designed to reverse these deficits.
Methods
Study Design
Detailed descriptions of the rationale and design of the Boston FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) study19 and the entire FICSIT trial20 have been published elsewhere. Briefly, the Boston FICSIT study was a randomized, placebo-controlled, 10-week clinical trial in which the subjects were assigned to receive lower-extremity resistance training, a multinutrient supplement, both treatments, or a placebo activity and supplement. The study was approved by the human investigations review committees at New England Medical Center and the Hebrew Rehabilitation Center for Aged, and written informed consent was obtained from each subject.Study Population
Volunteers were recruited from the residents of a 725-bed facility providing long-term care of the elderly. The criteria for inclusion were residential status, an age over 70 years, and the ability to walk 6 m. Subjects were excluded if they had severe cognitive impairment, rapidly progressive or terminal illness, acute illness or unstable chronic illness, myocardial infarction, fracture of a lower extremity within the six months before the study, or insulin-dependent diabetes mellitus; if they were on a weight-loss diet or undergoing resistance training at the time of enrollment; or if tests of muscle strength revealed a musculoskeletal or cardiovascular abnormality.Interventions
Resistance Training
Subjects assigned to exercise training underwent a regimen of high-intensity progressive resistance training21 of the hip and knee extensors 3 days per week for 10 weeks. These muscle groups were chosen because of their importance in functional activities22. For each muscle group, the resistance was set at 80 percent of the one-repetition maximum (the maximal load that could be lifted fully one time only)23. To maintain the intensity of the stimulus, the load was increased at each training session, as tolerated by the subject. Strength testing was repeated every two weeks to establish a new base-line value.Training sessions lasted 45 minutes and were separated by one day of rest. Each repetition lasted six to nine seconds, with a one- to two-second rest between repetitions and a two-minute rest between the three sets of eight lifts. All exercise sessions were supervised individually by a single exercise trainer, who was a certified therapeutic recreation specialist.
The knee extensors were trained with the use of the UNEX II chair (J.A. Preston, Clifton, N.J.). The hip extensors were trained in the first 53 subjects with the use of a wall-mounted cable-pulley system (G.E. Miller, New York). In the other 47 subjects, a double leg press (Keiser Sports Health Equipment, Fresno, Calif.) was used in place of the cable-pulley system, since it allowed for better positioning of the subject. There were no differences at base line or in treatment outcomes between subjects trained on these two machines............
http://www.nejm.org/doi/full/10.1056/NEJM199406233302501#t=article
Full Text / pdf / online im internet / Zugriff vom 04.10.2012 -
Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People :
http://web.missouri.edu/~brownmb/pt415/Mb/2007/articles/4.Fiatarone1994.pdf
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Factors Predicting Dynamic Balance and Quality of Life in Home-Dwelling Elderly Women
Abstract:
Background:
Proper balance seems to be a critical factor in terms of fall prevention among the elderly. Objective: The purpose of this cross-sectional study was to examine factors that are associated with dynamic balance and health-related quality of life in home-dwelling elderly women.
Methods:
One hundred and fifty-three healthy postmenopausal women (mean age: 72 years, height: 159 cm, weight: 72 kg) were examined. General health and physical activity were assessed by a questionnaire. Quality of life was measured using a health-related quality of life questionnaire (Rand 36-Item Health Survey 1.0). Dynamic balance (agility) was tested by a figure-of-eight running test. Static balance (postural sway) was tested on an unstable platform. Maximal isometric strength of the leg extensors was measured with a leg press dynamometer. Dynamic muscle strength of lower limbs was tested by measuring ground reaction forces with a force platform during common daily activities (sit-to-stand and step-on-a-stair tests).
Results:
Concerning physical activity, 33% of the subjects reported brisk exercise (walking, Nordic walking, cross-country skiing, swimming and aquatic exercises) at least twice a week, and 22% some kind of brisk activity once a week in addition to lighter physical exercise. The remaining 45% did not exercise regularly and were classified as sedentary. The correlations of step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength to dynamic balance were from –0.32 to –0.43 (the better the strength, the better the balance). In the regression analysis with backward elimination, step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength, age, brisk physical activity, number of diseases and dynamic postural stability explained 42% of the variance in the dynamic balance. Similarly, dynamic balance (figure-of-eight running time), number of diseases and walking more than 3 km per day explained 14% of the variance in the quality of life score. Of these, figure-of-eight running time was the strongest predictor of the quality of life score, explaining 9% of its variance.
Conclusion:
This study emphasizes the concept that in home-dwelling elderly women good muscle strength in lower limbs is crucial for proper body balance and that dynamic balance is an independent predictor of a standardized quality of life estimate. The results provide important and useful information when planning meaningful contents for studies related to fall prevention and quality of life and interventions in elderly women.
Quelle: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=82196&ProduktNr=230593
Training: www.training-baden-baden.de
Gesundheitsmanager: www.gesundheitsmanager-24.de
Background:
Proper balance seems to be a critical factor in terms of fall prevention among the elderly. Objective: The purpose of this cross-sectional study was to examine factors that are associated with dynamic balance and health-related quality of life in home-dwelling elderly women.
Methods:
One hundred and fifty-three healthy postmenopausal women (mean age: 72 years, height: 159 cm, weight: 72 kg) were examined. General health and physical activity were assessed by a questionnaire. Quality of life was measured using a health-related quality of life questionnaire (Rand 36-Item Health Survey 1.0). Dynamic balance (agility) was tested by a figure-of-eight running test. Static balance (postural sway) was tested on an unstable platform. Maximal isometric strength of the leg extensors was measured with a leg press dynamometer. Dynamic muscle strength of lower limbs was tested by measuring ground reaction forces with a force platform during common daily activities (sit-to-stand and step-on-a-stair tests).
Results:
Concerning physical activity, 33% of the subjects reported brisk exercise (walking, Nordic walking, cross-country skiing, swimming and aquatic exercises) at least twice a week, and 22% some kind of brisk activity once a week in addition to lighter physical exercise. The remaining 45% did not exercise regularly and were classified as sedentary. The correlations of step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength to dynamic balance were from –0.32 to –0.43 (the better the strength, the better the balance). In the regression analysis with backward elimination, step-on-a-stair and sit-to-stand ground reaction forces, and leg extensor strength, age, brisk physical activity, number of diseases and dynamic postural stability explained 42% of the variance in the dynamic balance. Similarly, dynamic balance (figure-of-eight running time), number of diseases and walking more than 3 km per day explained 14% of the variance in the quality of life score. Of these, figure-of-eight running time was the strongest predictor of the quality of life score, explaining 9% of its variance.
Conclusion:
This study emphasizes the concept that in home-dwelling elderly women good muscle strength in lower limbs is crucial for proper body balance and that dynamic balance is an independent predictor of a standardized quality of life estimate. The results provide important and useful information when planning meaningful contents for studies related to fall prevention and quality of life and interventions in elderly women.
Quelle: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstractBuch&ArtikelNr=82196&ProduktNr=230593
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Implementation of multifactorial interventions for fall and fracture prevention
Abstract
Over 60% of falls experienced by older
people result from multiple aetiological factors. Preventing falls in
individual patients
requires the identification and treatment of these
interacting factors. Multifactorial interventions have been successful
in some, but not all, fall prevention trials.
Preventing falls in populations requires selection of the population
most likely
to benefit, and selection of the particular
interventions shown to have been effective in this group. The
implementation of
preventive measures has been low despite strong
evidence that fall and fractures can be reduced. Misconceptions about
the
potential for prevention in old age, the time to
effect improvement, resource issues and the nature of the interventions
contribute
to the low uptake. An improved system of delivery
of proven preventive measures is needed.
Key words:
Quelle: http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.short
Full Text / Link / online im internet / Zugriff vom 04.10.2012:
Implementation of multifactorial interventions for fall and fracture prevention - Autoren:
http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.full.pdf+html
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Mittwoch, 3. Oktober 2012
Balance training program is highly effective
Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial
Direktlink / Full Text / pdf - online im internet - Zugriff vom 03.10.2012:
http://www.biomedsearch.com/attachments/00/17/08/90/17089080/198_2006_Article_252.pdf
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Direktlink / Full Text / pdf - online im internet - Zugriff vom 03.10.2012:
http://www.biomedsearch.com/attachments/00/17/08/90/17089080/198_2006_Article_252.pdf
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Systematic Review of Progressive Resistance Strength Training in Older Adults
Abstract
Background. The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to
reduce physical disability in older people.
Methods.
Randomized controlled trials were identified from searches of relevant
databases and study reference lists and contacts with
researchers. Two reviewers independently screened
the trials for eligibility, rated their quality, and extracted data.
Only
randomized controlled trials utilizing PRT as the
primary intervention in participants, whose group mean age was 60 years
or older, were included. Data were pooled using
fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest.
Results. 62 trials (n
= 3674) compared PRT with a control group. 14 trials had data available
to allow pooling of disability outcomes. Most trials
were of poor quality. PRT showed a strong positive
effect on strength, although there was significant heterogeneity (41
trials
[n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such
as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI −0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined
and prospectively monitored.
Conclusions. PRT
results in improvements to muscle strength and some aspects of
functional limitation, such as gait speed, in older adults.
However, based on current data, the effect of PRT
on physical disability remains unclear. Further, due to the poor
reporting
of adverse events in trials, it is difficult to
evaluate the risks associated with PRT.
Quelle: http://biomedgerontology.oxfordjournals.org/content/59/1/M48.short
Hier der Download-Link zu: Systematic Review of Progressive Resistance Strength Reistance Strength Training in Older Adults:
http://www.bewegenismedicijn.nl/files/downloads/latham_et_al._2004_-_prt_in_older_adults.pdf
Hier der Link zum Cochrane-Review von LIU und LATHAM - 2009:
"Progressive Resistance Strength Training for improving physical function in older adults" (277 Seiten)
http://www.cfah.org/hbns/archives/viewSupportDoc.cfm?supportingDocID=806
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Falls in the nursing home
ABSTRACT von 1994
Quelle: http://www.ncbi.nlm.nih.gov/pubmed/8053619
Full Text / pdf / RUBENSTEIN et al. - Falls in the nursing home - http://mcintranet.musc.edu/agingq3/documents/images/Rubenstein_Falls%20in%20the%20Nursing%20Home.pdf
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OBJECTIVE:
To review the epidemiology and causes of falls and fall-related injuries in nursing homes and to provide clinicians with a structured framework to evaluate and treat nursing home residents at risk for falls.DATA SOURCES:
All large-scale published studies documenting incidence, causes, risk factors, and preventive strategies for falls in nursing homes were reviewed.RESULTS:
The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range, 0.2 to 3.6 falls). The most common precipitating causes include gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension. The most important underlying risk factors for falls and injuries include some of these same items and others, such as lower-extremity weakness, gait and balance instability, poor vision, cognitive and functional impairment, and sedating and psychoactive medications. Many strategies for the prevention of falls have been tried, with mixed success. The most successful consider the multifactorial causes of falls and include interventions to improve strength and functional status, reduce environmental hazards, and allow staff to identify and monitor high-risk residents. Strategies that reduce mobility through use of restraints have been shown to be more harmful than beneficial and should be avoided.CONCLUSIONS:
A focused history and physical examination after a fall can usually determine both the immediate underlying causes of the fall and contributing risk factors. In addition, regular evaluations in the nursing home can help identify patients at high risk who can then be targeted for specific treatment and prevention strategies.Quelle: http://www.ncbi.nlm.nih.gov/pubmed/8053619
Full Text / pdf / RUBENSTEIN et al. - Falls in the nursing home - http://mcintranet.musc.edu/agingq3/documents/images/Rubenstein_Falls%20in%20the%20Nursing%20Home.pdf
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Effectiveness of a Multifaceted Intervention on Falls
Abstract: Effectiveness of a Multifaceted Intervention on Falls in Nursing Home Residents - Clemens Becker et al -
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2003.51103.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true
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Article first published online: 20 FEB 2003
DOI: 10.1046/j.1532-5415.2003.51103.x
ABSTRACT
Keywords:
- accidental falls;
- older people;
- prevention;
- hip protector;
- exercise
OBJECTIVES: To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers.
DESIGN: Prospective, cluster-randomized, controlled 12-month trial.
SETTING: Six community nursing homes in Germany.
PARTICIPANTS: Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female.
INTERVENTIONS:
Staff and resident education on fall prevention, advice on
environmental adaptations, progressive balance and resistance training,
and hip protectors.
MEASUREMENTS: Falls, fallers, and fractures.
RESULTS:
The incidence density rate of falls per 1,000 resident years (RY) was
2,558 for the control group (CG) and 1,399 for the intervention group
(IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) =
0.41–0.73). Two hundred forty-seven (52.3%) fallers were detected in the
CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The
incidence density rate of frequent fallers (>2/year) was 115 (24.4%)
for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89).
The incidence density rate of hip fractures per 1,000 RY was 39 for the
CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures
were diagnosed with an incidence density rate of 52 per 1,000 RY for CG
and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07).
CONCLUSION:
The incidence density rate of falls and fallers differed considerably
between the control and intervention groups. The study was underpowered
to demonstrate a significant difference of hip or nonhip fractures.
Because of a low fracture rate in both groups, the investigation of
fracture rates would have required a larger sample size to detect an
effect of the intervention.
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2003.51103.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true
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Intense Tai Chi Exercise Training and Fall Occurrences
Abstract: Intense Tai Chi Exercise Training and Fall Occurrences in Older, Transitionally Frail Adults: A Randomized, Controlled Trial
Keywords:
- exercise;
- falls;
- balance;
- aging;
- tai chi
Objectives:
To determine whether an intense tai chi (TC) exercise program could
reduce the risk of falls more than a wellness education (WE) program in
older adults meeting criteria for transitioning to frailty.
Design: Randomized, controlled trial of 48 weeks duration.
Setting: Twenty congregate living facilities in the greater Atlanta area.
Participants: Sample of 291 women and 20 men aged 70 to 97.
Measurements:
Demographics, time to first fall and all subsequent falls, functional
measures, Sickness Impact Profile, Centers for Epidemiologic Studies—Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions.
Results:
The risk ratio (RR) of falling was not statistically different in the
TC group and the WE group (RR=0.75, 95% confidence interval
(CI)=0.52–1.08), P=.13). Over the 48 weeks of intervention, 46%
(n=132) of the participants did not fall; the percentage of
participants that fell at least once was 47.6% for the TC group and
60.3% for the WE group.
Conclusion:
TC did not reduce the RR of falling in transitionally frail, older
adults, but the direction of effect observed in this study, together
with positive findings seen previously in more-robust older adults,
suggests that TC may be clinically important and should be evaluated
further in this high-risk population.
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2003.51552.x/abstract
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2003.51552.x/abstract
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Montag, 1. Oktober 2012
The Effect of Multidimensional Exercises .....
....... on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults
Quelle: http://www.physicaltherapyjournal.com/content/77/1/46.short
Full Text / pdf - online im internet - Zugriff 01.10.2012 - The Effect of Multidimensional Exercises on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults
http://www.physicaltherapyjournal.com/content/77/1/46.full.pdf+html
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Abstract
Background and Purpose.
This prospective clinical investigation examined the effects of a
multidimensional exercise program on balance, mobility,
and risk for falls in community-dwelling older
adults with a history of falling. Factors used to predict adherence and a
successful
response to exercise were identified.
Subjects.
A total of 105 community-dwelling older adults (≥65 years of age) with a
history of two or more falls in the previous 6 months
(no neurologic diagnosis) participated. They were
classified into (1) a control group of fallers (n=21), (2) a fully
adherent
exercise group (n=52), and (3) a partially adherent
exercise group (n=32).
Methods. Following evaluation,
each patient received an individualized exercise program addressing the
impairments and functional
disabilities identified during the assessment. The
control group received no intervention. Changes in performance on five
clinical tests of balance and mobility and fall
risk were compared among groups.
Results. Both exercise
groups scored better than the control group on all measures of balance
and mobility. Although both exercise
groups showed a reduction in fall risk compared
with the control group, the greatest reduction was found in the fully
adherent
exercise group. Factors associated with successful
response to exercise included degree of adherence to exercise program
and
pretest score on the Tinetti Mobility Assessment.
Conclusion and Discussion.
Exercise can improve balance and mobility function and reduce the
likelihood for falls among community-dwelling older adults
with a history of falling. The amount of exercise
needed to achieve these results, however, could not be determined from
this
study.
Quelle: http://www.physicaltherapyjournal.com/content/77/1/46.short
Full Text / pdf - online im internet - Zugriff 01.10.2012 - The Effect of Multidimensional Exercises on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults
http://www.physicaltherapyjournal.com/content/77/1/46.full.pdf+html
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Interventions for the prevention of falls in older adults
A systematic review and meta-analysis of randomised clinical trials -
Autoren:
Full Text / pdf - online im internet - Zugriff: 01.10.2012 - Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
http://mcintranet.musc.edu/agingq3/documents/images/Chang_Interventions%20for%20the%20Prevention%20of%20Falls.pdf
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Autoren:
Abstract
Objective
To assess the relative effectiveness of interventions to prevent falls
in older adults to either a usual care group or control group.
Design Systematic review and meta-analyses.
Data sources
Medline, HealthSTAR, Embase, the Cochrane Library, other health related
databases, and the reference lists from review articles and systematic
reviews.
Data extraction Components of
falls intervention: multifactorial falls risk assessment with management
programme, exercise, environmental modifications, or education.
Results
40 trials were identified. A random effects analysis combining trials
with risk ratio data showed a reduction in the risk of falling (risk
ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining
trials with incidence rate data showed a reduction in the monthly rate
of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of
individual components was assessed by meta-regression. A multifactorial
falls risk assessment and management programme was the most effective
component on risk of falling (0.82, 0.72 to 0.94, number needed to treat
11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in
treatment group per 100 patients per month). Exercise interventions also
had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99,
number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01;
2.7).
Conclusions Interventions to
prevent falls in older adults are effective in reducing both the risk of
falling and the monthly rate of falling. The most effective
intervention was a multifactorial falls risk assessment and management
programme. Exercise programmes were also effective in reducing the risk
of falling.
Quelle und Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC381224/
http://mcintranet.musc.edu/agingq3/documents/images/Chang_Interventions%20for%20the%20Prevention%20of%20Falls.pdf
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Effects of a Group Exercise Program on Strength, Mobility, and Falls
Among Fall-Prone Elderly Men / by:
Full Text / pdf - online im internet - Zugriff 01.10.12
http://web.missouri.edu/~brownmb/pt415/Mb/2008/Rubenstein-2000-mobilitiy-and-fall-rate_J_Gerontol_A-FULL.pdf
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- Laurence Z. Rubenstein a ,
- Karen R. Josephson a ,
- Peggy R. Trueblood b ,
- Steven Loy c ,
- Judith O. Harker a ,
- Fern M. Pietruszka a and
- Alan S. Robbins
Abstract
Objectives. This randomized controlled trial studied the effects of a low- to moderate-intensity group exercise program on strength,
endurance, mobility, and fall rates in fall-prone elderly men with chronic impairments.
Methods. Fifty-nine community-living men 
with specific fall risk factors (i.e., leg weakness, impaired gait or balance, previous falls) were randomly assigned to
a control group 
or to a 12-week group exercise program 
.
Exercise sessions (90 minutes, three times per week) focused on
increasing strength and endurance and improving mobility
and balance. Outcome measures included isokinetic
strength and endurance, five physical performance measures, and
self-reported
physical functioning, health perception, activity
level, and falls.
with specific fall risk factors (i.e., leg weakness, impaired gait or balance, previous falls) were randomly assigned to
a control group or to a 12-week group exercise program .
Exercise sessions (90 minutes, three times per week) focused on
increasing strength and endurance and improving mobility
and balance. Outcome measures included isokinetic
strength and endurance, five physical performance measures, and
self-reported
physical functioning, health perception, activity
level, and falls.
Results. Exercisers showed significant improvement in measures of endurance and gait. Isokinetic endurance increased 21% for right
knee flexion and 26% for extension. Exercisers had a 10% increase ( p < .05) in distance walked in six minutes, and improved ( p
< .05) scores on an observational gait scale. Isokinetic strength
improved only for right knee flexion. Exercise achieved
no significant effect on hip or ankle strength,
balance, self-reported physical functioning, or number of falls.
Activity
level increased within the exercise group. When
fall rates were adjusted for activity level, the exercisers had a lower
3-month
fall rate than controls (6 falls/1000 hours of
activity vs 16.2 falls/1000 hours, p < .05).
Discussion.
These findings suggest that exercise can improve endurance, strength,
gait, and function in chronically impaired, fall-prone
elderly persons. In addition, increased physical
activity was associated with reduced fall rates when adjusted for level
of
activity.
Full Text / pdf - online im internet - Zugriff 01.10.12
http://web.missouri.edu/~brownmb/pt415/Mb/2008/Rubenstein-2000-mobilitiy-and-fall-rate_J_Gerontol_A-FULL.pdf
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Practical implementation of an exercise‐based falls prevention programme
Abstract
Muscle weakness and impaired balance are
risk factors underlying many falls and fall injuries experienced by
older people.
Fall prevention strategies have included exercise
programmes that lower the risk of falling by improving strength and
balance.
We have developed an individually tailored,
home‐based, strength and balance retraining programme, which has proven
successful
in reducing falls and moderate fall injuries in
people aged 80 years and older. Here we describe a simple assessment of
strength
and balance and the content and delivery of a falls
prevention exercise programme.
Key words:exercise; falls; older people
Quelle: http://ageing.oxfordjournals.org/content/30/1/77.short
Online im internet - Zugriff 01.10.2012 -
Practical implementation of an exercise‐based falls prevention programme -
Full Text / pdf: http://ageing.oxfordjournals.org/content/30/1/77.full.pdf+html
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Sonntag, 30. September 2012
Strength training in the elderly
Effects on risk factors for age-related diseases / by: Hurley BF, Roth SM.
Source: Department of Kinesiology, College of Health & Human Performance, University of Maryland, College Park 20742, USA. bh24@umail.umd.edu
Abstract
Strength training (ST) is considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure that is associated with advanced age.This reversal is thought to result in improvements in functional abilities and health status in the elderly by increasing muscle mass, strength and power and by increasing bone mineral density (BMD).
In the past couple of decades, many studies have examined the effects of ST on risk factors for age-related diseases or disabilities.
Collectively, these studies indicate that ST in the elderly: (i) is an effective intervention against sarcopenia because it produces substantial increases in the strength, mass, power and quality of skeletal muscle; (ii) can increase endurance performance; (iii) normalises blood pressure in those with high normal values; (iv) reduces insulin resistance; (v) decreases both total and intra-abdominal fat; (vi) increases resting metabolic rate in older men; (vii) prevents the loss of BMD with age; (viii) reduces risk factors for falls; and (ix) may reduce pain and improve function in those with osteoarthritis in the knee region.
However, contrary to popular belief, ST does not increase maximal oxygen uptake beyond normal variations, improve lipoprotein or lipid profiles, or improve flexibility in the elderly.
Quelle: http://www.ncbi.nlm.nih.gov/pubmed/11048773
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Exercise Training for Rehabilitation and Secondary Prevention of Falls
Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls
Abstract
Keywords:
- geriatric patients;
- injurious falls;
- physical training
OBJECTIVE:
To determine the safety and efficacy of an exercise protocol designed
to improve strength, mobility, and balance and to reduce subsequent
falls in geriatric patients with a history of injurious falls.
DESIGN: A randomized controlled 3-month intervention trial, with an additional 3-month follow-up.
SETTING: Out-patient geriatric rehabilitation unit.
PARTICIPANTS:
Fifty-seven female geriatric patients (mean age 82 ± 4.8 years; range
75–90) admitted to acute care or inpatient rehabilitation with a history
of recurrent or injurious falls including patients with acute
fall-related fracture.
INTERVENTION:
Ambulatory training of strength, functional performance, and balance 3
times per week for 3 months. Patients of the control group attended a
placebo group 3 times a week for 3 months. Both groups received an
identical physiotherapeutic treatment 2 times a week, in which
strengthening and balance training were excluded.
MEASUREMENTS:
Strength, functional ability, motor function, psychological parameters,
and fall rates were assessed by standardized protocols at the beginning
(T1) and the end (T2) of intervention. Patients were followed up for 3
months after the intervention (T3).
RESULTS:
No training-related medical problems occurred in the study group.
Forty-five patients (79%) completed all assessments after the
intervention and follow-up period. Adherence was excellent in both
groups (intervention 85.4 ± 27.8% vs control 84.2 ± 29.3%).
The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses.
For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455–1.245).
The patients in the intervention group increased strength, functional motor performance, and balance significantly. Fall-related behavioral and emotional restrictions were reduced significantly. Improvements persisted during the 3-month follow-up with only moderate losses.
For patients of the control group, no change in strength, functional performance, or emotional status could be documented during intervention and follow-up. Fall incidence was reduced nonsignificantly by 25% in the intervention group compared with the control group (RR:0.753 CI:0.455–1.245).
CONCLUSIONS:
Progressive resistance training and progressive functional training are
safe and effective methods of increasing strength and functional
performance and reducing fall-related behavioral and emotional
restrictions during ambulant rehabilitation in frail, high-risk
geriatric patients with a history of injurious falls.
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2001.49004.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true
Quelle: http://onlinelibrary.wiley.com/doi/10.1046/j.1532-5415.2001.49004.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true
Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls
Online im internet - Zugriff: 30.09.2012 . Full Text / pdf:http://knowledgetranslation.ca/sysrev/articles/project51/Hauer2001.pdf
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Effective Exercise for the Prevention of Falls
A Systematic Review and Meta-Analysis
Keywords:
- falls;
- exercise;
- meta-analysis
Abstract
OBJECTIVES:
To determine the effects of exercise on falls prevention in older
people and establish whether particular trial characteristics or
components of exercise programs are associated with larger reductions in
falls.
DESIGN: Systematic review
with meta-analysis. Randomized controlled trials that compared fall
rates in older people who undertook exercise programs with fall rates in
those who did not exercise were included.
SETTING: Older people.
PARTICIPANTS: General community and residential care.
MEASUREMENTS: Fall rates.
RESULTS:
The pooled estimate of the effect of exercise was that it reduced the
rate of falling by 17% (44 trials with 9,603 participants, rate ratio
(RR)=0.83, 95% confidence interval (CI)=0.75–0.91, P<.001, I2=62%).
The greatest relative effects of exercise on fall rates (RR=0.58, 95%
CI=0.48–0.69, 68% of between-study variability explained) were seen in
programs that included a combination of a higher total dose of exercise
(>50 hours over the trial period) and challenging balance exercises
(exercises conducted while standing in which people aimed to stand with
their feet closer together or on one leg, minimize use of their hands to
assist, and practice controlled movements of the center of mass) and
did not include a walking program.
CONCLUSION:
Exercise can prevent falls in older people. Greater relative effects
are seen in programs that include exercises that challenge balance, use a
higher dose of exercise, and do not include a walking program. Service
providers can use these findings to design and implement exercise
programs for falls prevention.
Quelle und Full Text - Zugriff 30.09.2012:
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full
Quelle und Full Text - Zugriff 30.09.2012:
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.02014.x/full
Effective Exercise for the prevention of falls: A systematic review and meta-analysis
Full Text / pdf:
http://www.laterlifetraining.co.uk/wp-content/uploads/2011/12/Sherrington_Ex_Int_Review_2008_JAGS.pdf
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Exercise in the Prevention of Falls in Older People
A Systematic Literature Review Examining the Rationale and the Evidence
Authors: Carter N.D.; Kannus P; Khan K.M.
Source: Sports Medicine, Volume 31, Number 6, 1 June 2001 , pp. 427-438(12)
Source: Sports Medicine, Volume 31, Number 6, 1 June 2001 , pp. 427-438(12)
Abstract:
Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults.
Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars. Age-related changes in the physiological systems (somatosensory, vestibular and visual) which contribute to the maintenance of balance are well documented in older adults.
These changes coupled with
age-related changes in muscle and bone are likely to contribute to an
increased risk of falls in this population. The integrated
rehabilitation-based model of fall risk factors reveals multiple sites
for interventions that may reverse fall risk factors. Regular exercise
may be one way of preventing falls and fall-related fractures.
The
evidence for this contention comes from a variety of sources. On the
basis of 9 randomised controlled studies conducted since 1996, exercise
appears to be a useful tool in fall prevention in older adults,
significantly reducing the incidence of falls compared with control
groups.
However, current limitations such as inconsistencies in the
measurement of key dependent and independent variables do not, at
present, permit a meta-analysis of intervention trials. Further
investigation, using trials designed with the current limitations in
mind, is necessary to establish the optimum exercise programme to
maximise fall prevention in older adults.
Document Type: Review article
Quelle: http://www.ingentaconnect.com/content/adis/smd/2001/00000031/00000006/art00003
Exercise in the prevention of falls in oder people: Full Text / pdf
http://resources.glos.ac.uk/shareddata/dms/0EEB551FBCD42A0394BE4E0235DC08D2.pdf
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Systematic Review of Progressive Resistance Strength Training in Older Adults
systematic review von:
Abstract
Background. The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to
reduce physical disability in older people.
Methods.
Randomized controlled trials were identified from searches of relevant
databases and study reference lists and contacts with
researchers. Two reviewers independently screened
the trials for eligibility, rated their quality, and extracted data.
Only
randomized controlled trials utilizing PRT as the
primary intervention in participants, whose group mean age was 60 years
or older, were included. Data were pooled using
fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest.
Results. 62 trials (n
= 3674) compared PRT with a control group. 14 trials had data available
to allow pooling of disability outcomes. Most trials
were of poor quality. PRT showed a strong positive
effect on strength, although there was significant heterogeneity (41
trials
[n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such
as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI −0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined
and prospectively monitored.
Conclusions. PRT
results in improvements to muscle strength and some aspects of
functional limitation, such as gait speed, in older adults.
However, based on current data, the effect of PRT
on physical disability remains unclear. Further, due to the poor
reporting
of adverse events in trials, it is difficult to
evaluate the risks associated with PRT.
Quelle: http://biomedgerontology.oxfordjournals.org/content/59/1/M48.short
Download Full Text / Google Scholar / Ähnliche Artikel: latham_et_al._2004_-_prt_in_older_adults-1.pdf
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