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

Klaus Hauer PhD¹,
Brenda Rost¹,
Kirstin Rütschle¹,
Hedda Opitz¹,
Norbert Specht MD¹,
Peter Bärtsch MD²,
Peter Oster MD¹,
Günter Schlierf MD¹

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).

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

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

Catherine Sherrington
Julie C. Whitney
Stephen R. Lord
Robert D. Herbert
Robert G. Cumming
Jacqueline C. T. Close

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

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)

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.

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.

Keywords: Elderly; Exercise therapy

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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Prevention of falls and consequent injuries in elderly people

Review / von:

^a Accident & Trauma Research Centre, UKK Institute for Health Promotion Research, Tampere, Finland
^b Department of Surgery, Tampere University Medical School and University Hospital, Tampere, Finland
^c Tampere Research Centre of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland

Abstract / Summary

Injuries resulting from falls in elderly people are a major public-health concern, representing one of the main causes of longstanding pain, functional impairment, disability, and death in this population.

The problem is going to worsen, since the rates of such injuries seem to be rising in many areas, as is the number of elderly people in both the developed and developing world.

Many methods and programmes to prevent such injuries already exist, including regular exercise, vitamin D and calcium supplementation, withdrawal of psychotropic medication, cataract surgery, professional environment hazard assessment and modification, hip protectors, and multifactorial preventive programmes for simultaneous assessment and reduction of many of the predisposing and situational risk factors.

To receive broader-scale effectiveness, these programmes will need systematic implementation. Care must be taken, however, to rigorously select the right actions for those people most likely to benefit, such as vitamin D and calcium supplementation and hip protectors for elderly people living in institutions.

Quelle: http://www.sciencedirect.com/science/article/pii/S0140673605676040

Prevention of falls and consequent injuries in elderly people - Full Text / pdf:

http://www.grg-bs.it/usr_files/eventi/journal_club/programma/falls_lancet.pdf

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Control of rapid limb movements for balance recovery

age-related changes and implications for fall prevention

Brian E. Maki ¹ , ² and
William E. McIlroy ² , ³

¹Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
²Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
³Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada

Address correspondence to: B. E. Maki, Centre for Studies in Aging, Sunnybrook Health Sciences, Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5. Tel: (+1) 416 480 6100x3513; Fax: (+1) 416 480 5856. Email: brian.maki@sri.utoronto.ca

Abstract

Background: balancing reactions that involve rapid stepping or reaching movements are critical for preventing falls. These compensatory reactions are much more rapid than volitional limb movements and can be very effective in decelerating the centre-of-mass motion induced by sudden unpredictable balance perturbation; however, age-related deterioration in the neural, sensory and/or musculoskeletal systems may impede the ability to execute these reactions effectively.

Objective: this paper summarises recent research regarding age-related changes in compensatory stepping and reaching reactions and the practical implications of these findings for fall prevention programmes.

Results: even healthy older adults experience pronounced difficulties. For stepping reactions, the main problems pertain to control of lateral stability—arresting the lateral body motion that occurs during forward and backward steps, and controlling lateral foot movement so as to avoid collision with the stance limb during lateral steps. Older adults appear to be more reliant on arm reactions than young adults but are less able to execute reach-to-grasp reactions rapidly.

Conclusions: it is important for clinicians to assess compensatory stepping and reaching, in order to identify individuals who are at risk of falling and to pinpoint specific control problems to target for balance or strength training or other intervention. More effective use of stepping and reaching reactions can be promoted through improved design and appropriate use of sensory aids, mobility aids, footwear, handrails and grab-bars. It is particularly important to address the problems associated with the control of lateral stability because it is the lateral falls that are most likely to result in hip fracture.

Key words

Quelle: http://ageing.oxfordjournals.org/content/35/suppl_2/ii12.short

Full Text / pdf: http://ageing.oxfordjournals.org/content/35/suppl_2/ii12.full.pdf

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The effect of strength and endurance training on gait, balance, fall risk,......

......., and health services use in community-living older adults.

Buchner DM, Cress ME, de Lateur BJ, Esselman PC, Margherita AJ, Price R, Wagner EH

Department of Health Services, University of Washington, Seattle, USA. buchner@u.washington.edu

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences [1997, 52(4):M218-24]

Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.

Abstract

BACKGROUND: The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults.

METHODS: The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization. The intervention was supervised exercise (1-h sessions, three per week, for 24-26 weeks), followed by self-supervised exercise. Exercise groups included strength training using weight machines (n = 25), endurance training using bicycles (n = 25), and strength and endurance training (n = 25). Study outcomes included gait tests, balance tests, physical health status measures, self-reported falls (up to 25 months of follow-up), and inpatient and outpatient use and costs.

RESULTS: There were no effects of exercise on gait, balance, or physical health status. Exercise had a protective effect on risk of falling (relative hazard =.53, 95% CI =.30-.91). Between 7 and 18 months after randomization, control subjects had more outpatient clinic visits (p <.06) and were more likely to sustain hospital costs over $5000 (p <.05).

CONCLUSIONS: Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults. In community-living adults with mainly mild impairments in gait, balance, and physical health status, short-term exercise may not have a restorative effect on these impairments.

Quelle: http://ukpmc.ac.uk/abstract/MED/9224433

Full Text / pdf: http://www.cebp.nl/media/m785.pdf

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Samstag, 29. September 2012

Relationship between Balance Ability and Lower Extremity Muscular Strength in the Elderly

Comparison by Gender, Age, and Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence

Tatsuya HIRASE¹⁾, Shigeru INOKUCHI²⁾, Jun SHIOZUKA¹⁾, Kazumi NAKAHARA²⁾, Nobuou MATSUSAKA²⁾

1) Department of Rehabilitation Medicine, Nijigaoka Hospital 2) Department of Physical Therapy, Graduate School of Health Sciences, Nagasaki University

Released 2008/11/21

Keywords: the elderly, balance ability, lower extremity muscular strength

Abstract:

[Purpose] We studied the relationship between balance ability and lower extremity muscular strength in the elderly, and compared the data by gender, age, and the TMIG index of competence scores.

[Subjects] The subjects of this study were 69 persons with an average age of 77.4 years.

[Methods] Balance ability was assessed using center of gravity sway data for a static-standing posture and the Functional Reach Test (FRT) scores. Lower extremity muscular strength was assessed using measurements of knee extensor and ankle dorsiflexor strengths. For the age group analysis, subjects were divided into those above and below the median age(≤78 years and ≥79). For the activity level analysis, subjects were divided according to their TMIG index of competence score into those with scores of <11 and those with scores of ≥11.

[Results] The study showed that lower extremity strength was negatively correlated with sway of center of gravity and positively correlated with FRT scores. Negative correlation between sway of the center of gravity and lower extremity strength was observed in women aged ≥79 whose TMIG index of competence score was <11. In contrast, lower extremity strength was positively correlated with FRT in women aged ≤78 whose TMIG index of competence score was ≥11.

[Conclusion] In the elderly, there seem to be different characteristics that are dependent on physical ability in the relationship between balance ability and lower extremity muscular strength.

Quelle: https://www.jstage.jst.go.jp/article/rika/23/5/23_5_641/_article

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Regular Heel-raise Training Focused on the Soleus for the Elderly

Evaluation of Muscle Thickness by Ultrasound

Katsuo Fujiwara¹⁾, Hiroshi Toyama¹⁾, Hitoshi Asai²⁾, Kaoru Maeda³⁾, Chie Yaguchi¹⁾

1) Department of Human Movement and Health, Graduate School of Medical Science, Kanazawa University 2) Department of Physical Therapy, Graduate School of Medical Science, Kanazawa University 3) Department of Physical Therapy, Faculty of Health Sciences, Morinomiya University of Health Sciences

Released 2010/04/30

Keywords: muscle training, soleus, gastrocnemius, plantar flexor strength, the elderly

ABSTRACT

The soleus, one of the triceps surae muscles, greatly contributes to standing and walking. Strength training focused on the soleus could be important to prevent age-related deterioration in these functions.

We therefore investigated the effects of regular heel-raise training focused on the soleus for the elderly. Forty-nine healthy women aged 60 to 79 years trained for at least 40 days in a period of two months. Training consisted of a set of 100 repetitions per day of heel-raise with both legs in a standing position.

The training effect was evaluated by changes in each muscle thickness of the soleus and gastrocnemius medialis, which was measured using an ultrasound scanner, as well as plantar flexor strength.

The subjects' ability to perform the training and their subjective opinions of its effects were assessed by a questionnaire survey. Plantar flexor strength and thicknesses of the soleus and gastrocnemius medialis were increased significantly by the training.

The percentage increase in thickness was significantly greater for the soleus than for the gastrocnemius medialis (12.7% vs. 6.6%). These improvements did not significantly correlate with age.

The questionnaire results suggested that the elderly were able to safely and easily perform the heel-raise training at home. This study demonstrated that regular heel-raise training is an effective muscle training method for the elderly, focused on the soleus.

Quelle: https://www.jstage.jst.go.jp/article/jpa2/29/1/29_1_23/_article

Full Text / pdf:

https://www.jstage.jst.go.jp/article/jpa2/29/1/29_1_23/_pdf

Empfehlung: Training der Wadenmuskulatur, speziell des soleus.

Grafik: http://ikillfat.com/wp-content/uploads/2012/02/soleus.jpg?w=136

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Fall risk assessment and ......

.........knee extensor muscle activity in elderly people

Yukiko Oya¹⁾, Masumi Nakamura¹⁾, Emi Tabata¹⁾, Ryo Morizono¹⁾, Sachiko Mori¹⁾, Yukari Kimuro¹⁾, Etsuo Horikawa^{1) 2)}

1) Graduate School of Medicine, Saga University 2) Center for Comprehensive and Community Medicine, Faculty of Medicine, Saga University

Released 2008/07/14

Keywords: Community-dwelling elderly people, Falls, Knee extensor muscle, Peak latency, Hand-held dynamometer

ABSTRACT

Purpose: The purpose of this study was to analyze relationships between the history of falls, tripping, sway, and knee extensor muscle strengths as a tool for fall risk assessment in elderly people. We examined effective fall prevention measures.

Methods: We investigated 102 elderly volunteers in the community. The subjects were classified according to history of falls, tripping, sway and 5 performance tests conducted to assess fall risk including Timed up-and-go test (TUG), Functional Reach test (FR), Hand grip and Reaction time (RT). In addition, the time serial data of the knee extensor muscle strength were acquired using a hand-held dynamometer.

Results: In comparison to the non-faller group, the faller group showed a significantly higher incident rate of tripping and sway. A frequency analysis using the Maximum Entropy Method revealed that the fallers group showed lower peak frequency (p=0.025). Also, the slope of the logarithmical spectrum was less steep in the fallers group (p=0.035). Also results from analysis of the peak force latency from the beginning of measurement to 50%, 80%, and 100% muscle strength, also showed that the faller group took more time for maximal voluntary contraction.

Conclusions: The frequency analysis of the time series date of peak force latency of knee extensor muscle strength revealed that the muscle activity differs in faller compared to non-fallers. This study suggested that knee extensor muscle isometric performance could possibly be used as a new tool for fall risk assessment. We concluded that exercises to raise maximal muscle strength and muscle response speed are useful for the prevention of falls.

Quelle: https://www.jstage.jst.go.jp/article/geriatrics/45/3/45_3_308/_article

Der Full Text / pdf ist leider in japanischer Schrift.

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Donnerstag, 27. September 2012

Implementation of multifactorial interventions for fall and fracture prevention

A. John Campbell ¹ and
M. Clare Robertson

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.

Quelle: http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.short

Full Text / pdf: http://ageing.oxfordjournals.org/content/35/suppl_2/ii60.full.pdf+html

Keywords Google Scholar: exercise and fall-prevention

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A Review of Exercise Interventions for Fall Prevention in the Elderly

Gu MO, Jeon MY, Kim HJ, Eun Y. / Department of Nursing, Gyeong Sang National University: Gerontological Health Research Center, Gyeongsang Institute of Health Science. mogu@nongae.gsnu.ac.kr
Department of Nursing, Kuekdong College.
Department of Nursing, Chong Ju National College of Science and Technology.

Abstract

PURPOSE: This study was done to suggest directions for developing exercise interventions for fall prevention in the elderly in Korea in the future.

METHOD: Twenty five articles for fall prevention exercises were reviewed and analyzed.

RESULT: 84.0% of subjects were older adults age 65 and older living in the community. The most frequently performed interventions were lower limb strength and balance exercises together 43.3%, group exercise 70.0%, exercise 3 times/week 60.0%, 60 min per session 36.7%, duration of 12 weeks and 1 year 23.3% each. The most frequently used outcome variables were static balance 84.0%, lower limb muscle strength 72.0%, dynamic balance 56.0 %, and falls 56.0 %. The effect of exercise interventions on fall prevention was inconclusive. Lower limb strength exercises with resistance were effective for increasing muscle strength. Balance exercises with various movements for balance were effective for increasing balance.

CONCLUSION: Exercise interventions for fall prevention is recommended for older adults with risk factors of falling. The desirable type of exercise intervention is lower limb strength and balance exercise together.

Quelle: http://www.koreamed.org/SearchBasic.php?RID=1006JKAN/2005.35.6.1101&DT=1

Sturzprävention für Kleingruppen und Privatpersonen in Baden-Württemberg und nach Vereinbarung

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Intervention for the prevention of falls in elderly japanese women

von:Takao Suzuki, Hunkyung Kim, Hideyo Yoshida und Tatsuro Ishizaki

Link: http://www.springerlink.com/content/a2j9cwtn7a5vb3cb/

Zusammenfassung

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women.

The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention.

The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fisher rsquo

s exact test; P = 0.0097).

The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group.

We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.

Quelle: http://www.springerlink.com/content/a2j9cwtn7a5vb3cb/

Sturzprävention für Kleingruppen und Privatpersonen in Baden-Württemberg und nach Vereinbarung

JÖRG LINDER AKTIV-TRAINING

Mauerbergstraße 110

76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271

web: www.aktiv-training.de

Sturzprävention: www.sturztraining.de
Prävention: www.preventex.de
Mobility-Walking: http://mobility-walking.blogspot.com

Falls in older people: epidemiology, risk factors and strategies for prevention

Laurence Z. Rubenstein

Abstract

Falls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality and use of health care services including premature nursing home admissions.

Most of these falls are associated with one or more identifiable risk factors (e.g. weakness, unsteady gait, confusion and certain medications), and research has shown that attention to these risk factors can significantly reduce rates of falling.

Considerable evidence now documents that the most effective (and cost-effective) fall reduction programmes have involved systematic fall risk assessment and targeted interventions, exercise programmes and environmental-inspection and hazard-reduction programmes.

These findings have been substantiated by careful meta-analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence-based practice guidelines for fall prevention and management.

Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls.

Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co-existing medical conditions and environmental inspection and hazard abatement.

Quelle: http://ageing.oxfordjournals.org/content/35/suppl_2/ii37.short

pdf / Direktlink: http://ageing.oxfordjournals.org/content/35/suppl_2/ii37.full.pdf

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JÖRG LINDER AKTIV-TRAINING

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76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271

web: www.aktiv-training.de

Sturzprävention: www.sturztraining.de
Prävention: www.preventex.de
Mobility-Walking: http://mobility-walking.blogspot.com

Tai Chi: Improving functional balance and predicting subsequent falls in older persons

Résumé / Abstract

Purpose: To determine whether improved functional balance through a Tai Chi intervention is related to subsequent reductions in falls among elderly persons.

Methods: Two hundred fifty-six healthy, physically inactive older adults aged 70-92 (mean age ± SD = 77.48 ± 4.95), recruited from a local health system in Portland, OR, participated in a 6-month randomized controlled trial, with allocation to Tai Chi or exercise stretching control, followed by a 6-month postintervention follow-up. Functional balance measures included Berg balance scale, dynamic gait index, and functional reach, assessed during the 6-month intervention period (baseline, 3-month, and 6-month intervention endpoint) and again at the 6-month postintervention follow-up. Fall counts were recorded during the 6-month postintervention follow-up period. Data were analyzed through intention-to-treat analysis of variance and logistic regression procedures.

Results: Tai Chi participants who showed improvements in measures of functional balance at the intervention endpoint significantly reduced their risk of falls during the 6-month postintervention period, compared with those in the control condition (odds ratio (OR), 0.27, 95% confidence interval (CI), 0.07-0.96 for Berg balance scale; OR, 0.27, 95% CI, 0.09-0.87 for dynamic gait index; OR, 0.20, 95% CI, 0.05-0.82 for functional reach).

Conclusions: Improved functional balance through Tai Chi training is associated with subsequent reductions in fall frequency in older persons.

Quelle: http://cat.inist.fr/?aModele=afficheN&cpsidt=16330923

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Tel.: 07223 / 8004699

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Mail: info@aktiv-training.de

Fax: 07223 / 8005271

web: www.aktiv-training.de

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The Effect of Multidimensional Exercises on Balance, Mobility, and Fall Risk

The Effect of Multidimensional Exercises on Balance, Mobility, and Fall Risk in Community-Dwelling Older Adults

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

pdf Direktlink:

http://www.physicaltherapyjournal.com/content/77/1/46.full.pdf

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JÖRG LINDER AKTIV-TRAINING

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76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271

web: www.aktiv-training.de

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Donnerstag, 13. September 2012

A randomized controlled trial of fall prevention

A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities

Source:Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Umeå, Sweden. erik.rosendahl@ltu.se

Abstract

BACKGROUND AND AIMS:

Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities.

METHODS:

Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean+/-SD score on the Mini-Mental State Examination was 17.8+/-5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively.

RESULTS:

During the 6-month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03.

CONCLUSIONS:

In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/18283231

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Mail: info@aktiv-training.de

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Effects of a fall prevention program

Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities.

Abstract

BACKGROUND AND AIMS:

Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling.

METHODS:

187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering.

RESULTS:

At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. No association was found between improved mobility and reduced risk of falling.

CONCLUSIONS:

Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/15575122

JÖRG LINDER AKTIV-TRAINING

Mauerbergstraße 110

76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271

web: www.aktiv-training.de

weblog: www.aktiv-training.de/blog/

Gesundheitsmanagement: www.gesundheitsmanager-24.de
Sturzprävention: www.sturztraining.de

Effects of a group exercise program

Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men.

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 (mean age = 74 years) with specific fall risk factors (i.e., leg weakness, impaired gait or balance, previous falls) were randomly assigned to a control group (n = 28) or to a 12-week group exercise program (n = 31). 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.

Quelle: http://www.ncbi.nlm.nih.gov/pubmed/10843351

JÖRG LINDER AKTIV-TRAINING
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JÖRG LINDER AKTIV-TRAINING

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76534 Baden-Baden

Tel.: 07223 / 8004699

Mobil: 0177 / 4977232

Mail: info@aktiv-training.de

Fax: 07223 / 8005271

weblog: www.aktiv-training.de/blog/

Gesundheitsmanagement: www.gesundheitsmanager-24.de
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