Abstract
The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.
Highlights
Physical activities have been shown to ameliorate age-related risk factors associated with falls [1]
We recommend measuring the effectiveness and feasibility of inspiratory muscle training (IMT) on balance outcomes in frailer populations who are at a greater risk of falling. The findings of this pragmatic parallel study support our hypothesis that 8 weeks of unsupervised, individual, home-based IMT with healthy community-dwelling older adults, improves balance to a similar extent to supervised, group-based Otago exercise program (OEP) with healthy older care home-dwelling residents
The results showed that IMT improved dynamic balance, whereas the OEP improved static balance for our older participants
Summary
Thirty-seven older adults (79 ± 7 years) participated in the study. Exclusion criteria comprised: aged under 70 years, acute respiratory tract infection, or chronic lung disease (e.g. asthma and obstructive pulmonary disease), having fallen in the previous 24 months, diabetes, any heart conditions preventing physical activity, taking beta-blocker medication, vertigo in the past 6 months, currently undertaking balance exercise training (including Tai Chi and Pilates) and previous experience of IMT. Individuals with the following characteristics were excluded: low balance confidence (activities balance confidence scale [ABC] lower than 67%) [10], moderate low back pain (Oswestry low back pain questionnaire [ODI] higher than 20%) [11], and cognitive impairments (Mini-mental examination test [MMSE] lower than 24) [12]
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