Abstract
BackgroundStepping impairments are associated with physical and cognitive decline in older adults and increased fall risk. Exercise interventions can reduce fall risk, but adherence is often low. A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people.PurposeTo assess the feasibility and safety of unsupervised, home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people.DesignSingle-blinded two-arm randomized controlled trial comparing step pad training with control (no-intervention).Setting/ParticipantsThirty-seven older adults residing in independent-living units of a retirement village in Sydney, Australia.InterventionIntervention group (IG) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked (with a recommended dose of 2–3 sessions per week for 15–20 minutes each) for eight weeks. In addition, IG participants were asked to complete a choice stepping reaction time (CSRT) task once each week.Main Outcome MeasuresCSRT, the Physiological Profile Assessment (PPA), neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up.ResultsThirty-two participants completed the study (86.5%). IG participants played a median 2.75 sessions/week and no adverse events were reported. Compared to the control group, the IG significantly improved their CSRT (F31,1 = 18.203, p<.001), PPA composite scores (F31,1 = 12.706, p = 0.001), as well as the postural sway (F31,1 = 4.226, p = 0.049) and contrast sensitivity (F31,1 = 4.415, p = 0.044) PPA sub-component scores. In addition, the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task (F31,1 = 4.226, p = 0.049).ConclusionsStep pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12611001081909.
Highlights
Falls are very common in older people [1]
Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments
All but one Intervention group (IG) group participant enjoyed the step training and no adverse events related to the intervention were reported, suggesting step pad training is a safe mode of exercise for higher functioning older people
Summary
Falls are very common in older people [1]. Declines in physical and cognitive functioning, that have been identified as intrinsic fall risk factors [2,3], may lead to reduced capabilities for taking proactive and reactive steps in order to maintain balance [4,5]. Impaired stepping has been associated with falls in older people in several studies [6,7,8]. Physical exercises that include a balance component can reduce falls in older people [9]. A few studies have demonstrated improvements in parameters of fall risk in older people, such as enhancements of balance, reaction time and reactive responses to unpredictable balance perturbations [10,11,12]. Physical exercises may improve specific cognitive functions [13,14,15] that are associated with fall risk of older people. Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk. Purpose: To assess the feasibility and safety of unsupervised, home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people
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