Abstract
BackgroundWith increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fall prevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested.Methods/DesignHealthy old people (n = 54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale – International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version ('3 times 3’) that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period.DiscussionIt is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose–response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fall prevention.Trial registrationClinicalTrials.gov Identifier: NCT01906034
Highlights
With increasing age neuromuscular deficits may result in impaired physical performance and an increased risk for falls
It is expected that the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults
The proposed trial presented in this article will investigate the effects of a fall prevention exercise program developed by an expert panel on intrinsic fall risk factors, body composition, cognitive function, psychosocial well-being, and falls-self efficacy
Summary
The nationwide implementation of effective fall prevention exercise programs in industrial countries is limited. The present trial applies and evaluates a public practice guide for balance and strength / power training that may provide a feasible, safe, and effective approach for fall prevention in older adults. In contrast to an epidemiological approach, in this trial, we will conduct an intervention based on three major intrinsic fall risk factors (balance impairments, gait instabilities, and muscle weakness) This will allow the use of several extensive clinical and biomechanical measurement tools for evaluation purposes. Measuring gait velocity, grip strength and muscle mass will allow diagnosis of sarcopenia according to EWGSOP criteria, and may add knowledge to sensitivity and specificity of strength / power test to this important geriatric syndrome This trial will provide insight into the effect of fall prevention exercise applicable for a broad population and setting, both in community and sporting groups and at home. Critically revised, and approved the final version of the manuscript
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