Effects Of Balance Training Research Articles

Protocol for double-blinded randomized trial to enhance postural control after anterior cruciate ligament reconstruction by balance training and concurrent cognitive demands or external focus of attention

Anterior cruciate ligament (ACL) injury is one of the most common injuries among athletes that lead to postural control disorders. The aim of this study is to compare the effects of balance training with and without cognitive task and external focus of attention on postural control in individuals with ACL reconstruction. Sixty participants with ACL reconstruction, between the ages of 18 and 47 will be randomly allocated to three group's including routine balance training, balance training with external focus of attention. Patients will be assessed at the baseline, after receiving eight weeks of intervention, and four weeks later. A double-blinded design will be used. Center of pressure data acquired from a forceplate will be used to assess amount and velocity of sway, local dynamical stability, and global stability of upright balance. Also, dynamic balance will be assessed using Star Excursion balance test. The results of this research will be used to establish effectiveness of treatment strategies for postural control in individuals with anterior cruciate ligament reconstruction. The suggested interventions would be clinically applicable in the athlete with ACL injury.

Balance Training with Weight Shift-Triggered Electrical Stimulation for Stroke Patients: A Randomized Controlled Trial.

This study aimed to determine the effects of balance training with weight shift-triggered electrical stimulation to improve balance, lower-extremity motor function, and activities of daily living in patients with stroke. The participants were randomly allocated to the balance training with electrical stimulation group (BT-ESG, n = 29) or the balance training group (BTG, n = 30). Both groups were trained 5 times per week for 6 weeks for 50 min per session. To evaluate static balance, postural sway was assessed and dynamic balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and functional reach test (FRT). Lower-extremity motor function was assessed using the Fugl-Meyer assessment. Daily activities were assessed using the Modified Barthel Index. As for static balance, BT-ESG showed a significant improvement compared to BTG in postural swat in both the eyes-open (velocity moment; effect size, 0.88; 95% confidence interval, -1.16 to -1.30), or eyes-closed state (velocity moment; effect size, 0.81; 95% confidence interval, -1.22 to -0.27). Dynamic balance, which includes TUG (effect size, 0.90; 95% confidence interval, -4.67 to -1.25), BBS (effect size, 1.26; 95% confidence interval, -2.84 to 6.83), and FRT (effect size, 1.45; 95% confidence interval, 1.92 to 4.08), in addition to lower-extremity motor function (effect size, 1.38; 95% confidence interval, 2.25 to 4.97), and activities of daily living (effect size, 2.04; 95% confidence interval, 2.04 to 937), showed significant improvement in BT-ESG compared to BTG. These results suggest that balance training with weight shift-triggered electrical stimulation effectively improves balance, lower-extremity motor function, and activities of daily living in patients with stroke.

Balance training benefits chronic ankle instability with generalized joint hypermobility: a prospective cohort study

BackgroundBalance training is the first choice of treatment for chronic ankle instability (CAI). However, there is a lack of research on the effects of balance training in CAI with generalized joint hypermobility (GJH). This study is to compare the outcomes of balance training in CAI patients with and without GJH.MethodsForty CAI patients were assigned into the GJH group (Beighton ≥ 4, 20) and non-GJH group (Beighton < 4, 20) and they received same 3-month supervised balance training. Repeated measure ANOVA and independent t test were used to analyze self-reported questionnaires (Foot and ankle ability measure, FAAM), the number of patients experiencing ankle sprain, isokinetic muscle strength and postural control tests (Star excursion balance test, SEBT and Balance errors system, BES) before training, post-training immediately, and post-training 3 months, respectively.ResultsAt baseline, no differences were found between groups with except for GJH group having poorer SEBT in the posteromedial direction (83.6 ± 10.1 vs 92.8 ± 12.3, %) and in the posterolateral direction (84.7 ± 11.7 vs 95.7 ± 8.7, %). Following the balance training, GJH group demonstrated lower re-sprain ratio (immediately after training, 11.1% vs 23.5%, 3 month after training, 16.7% vs 29.4%) than non-GJH group, as well as greater FAAM-S score, plantarflexion strength and dorsiflexion strength at post-training immediately and 3 months, and both groups improved similarly in the FAAM-A score, muscle strength and balance control (SEBT in the posterior-lateral and posterior-medial directions, and BES scores) compared with baseline.ConclusionsCAI patients with GJH gained equally even better postural stability and muscle strength after the balance training than the non-GJH patients. Balance training could still be an effective treatment for CAI patients with GJH before considering surgery.Trial registrationChiCTR1900023999, June 21st, 2019.

Effects of balance training in addition to auxiliary activity on balance function of patients with stroke at high risk for falls.

The aim of this study was to investigate the effect of balance training in addition to auxiliary activity on the balance function of patients with stroke at high risk for falls. A total of 112 patients with stroke at high risk for falls in our hospital from inception to January 2020 to December 2020 were selected as the research objects who were equally divided into the control group and study group according to the random number table method. Patients in the control group were intervened with auxiliary activity, and the patients in the study group received additional balance training for auxiliary activity. The balance function, lower extremity motor function, fall risk, walking ability, and other indicators were compared between the two groups of patients before and after treatment. The hospitalization time and the frequency of falls 3 months after discharge were also compared between the two groups. Before treatment, there was no significant difference in balance function, lower extremity motor function, fall risk, and walking ability scores between the two groups (P > 0.05). After 3 months of treatment, the balance function, lower extremity motor function, and walking ability scores of the study group were significantly higher than those of the control group, with the fall risk score significantly lower than that of the control group (P < 0.05). Evidently, lower hospitalization time and the frequency of falls in the 3-month follow-up of the study group were observed than those in the control group (P < 0.05). However, there was no significant difference in the frequency of falls between the two groups during hospitalization (P > 0.05). Our results indeed revealed that balance training in addition to auxiliary activity elicited beneficial outcomes in terms of effectively improving the balance function and walking ability of patients with stroke at high risk of falling, which may have the potential for wide clinical application.

TREINAMENTO DE EQUILÍBRIO E HABILIDADE FÍSICA DOS JOGADORES DE BASQUETEBOL

ABSTRACT Introduction Balance in gait is a fundamental factor for rhythmic changes on the court, and physical fitness is a basic requirement for competitiveness in basketball. Objective Analyze the effects of balance training on the gait and physical fitness of basketball players. Methods Thirty basketball athletes were selected and randomly divided into a control and experimental group. A balance training program including balls was added to the experimental group, while the control group followed only the traditional training program. The experiment lasted 8 weeks, with the interventions applied 3 times a week. Finally, relevant data collected before and after the experiment were statistically analyzed and discussed. Results The experimental and the control groups showed a statistical gain in balance, with a greater change interval in the experimental group, demonstrating the effect of dynamic balance training in improving basketball-related physical indices. Conclusion There are some deficiencies in the traditional basketball training program that can be compensated with the addition of the balance training program presented in this article, fully improving the skills of basketball players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

INFLUÊNCIAS DO TREINO DE EQUILÍBRIO SOBRE A APTIDÃO FÍSICA DOS ATLETAS DE ARTES MARCIAIS

ABSTRACT Introduction: Chinese martial arts constitute an integral sport, demanding high capacity and physical fitness from its athletes. It is believed that functional balance training can enhance the performance of its athletes, as it strengthens and tones the muscles, stimulating the active proprioception of the executed movements. Objective: This paper investigates the effect of balance training on martial arts athletes and its impact on the execution of complex sports movements. Methods: Under experimental control, 100 martial arts athletes were selected and divided into two groups without statistical differences to perform the experiment. The experimental group added balance training, while the control group followed the usual training script. Sports fitness indices were measured before and after the intervention for statistical analysis. Results: The data regarding the balance index of the experimental group pre was 7.00±0.52, and after the experiment, it went to 8.40±0.47; the functional indices increased from 7.50±0.55 to 8.46±0.42. No statistically relevant changes were found in the control group. Conclusion: Functional balance training can complement daily training routines for greater benefits in martial arts athletes. The improvement of active proprioception statistically increases the ability of its practitioners in the execution of complex movements. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

EFEITO DO TREINAMENTO DE EQUILÍBRIO NO ENSINO DE AERÓBICA PARA UNIVERSITÁRIOS

ABSTRACT Introduction: Among the known benefits of aerobics gymnastics are flexibility, motor coordination improvement, weight loss, and balance improvement. The balance capacity is very important for aerobics students, and it is believed that introducing a complementary protocol can bring greater benefits to the performance of its practitioners. Objective: Explore the effects of balance training on university students practicing aerobics. Methods: A 9-week experiment was conducted employing 100 college aerobics students. The volunteers were divided into two groups without statistical differences. Balance training was added to the experimental group, while the control group remained with daily teaching practice. Results: The push-up score increased from 2.27±0.45 to 2.73±0.46, the body rotation score was from 1.87±0.35 to 2.40±0.51, and the squat score was from 2.53±0.52 to 3.03±0.30. While the aerobic ability of college students in the experimental group was effectively improved, no significant changes were observed in the control group data. Conclusion: Balance training can effectively improve college students’ ability, leading to improvement in teaching aerobics to college students. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Effects of Balance Training on Trunk Control and Postural Stability in patients with Sub-Acute Stroke

Aim: To compare the effects of balance training on trunk control and postural stability in patients with sub-acute stroke Methods: A randomized control trial study was carried out with a total of 60 stroke patients. Both males and females, aged above 40 years, were able to stand for at least 5 minutes without any support, and patients on grades 2, 3, and 4 on a scale of functional mobility were included in the study. Each group has a session of training for 40 minutes, 3 times per week for 6 weeks Berg Balance Scale was used for assessment. The valuation was done at baseline 3rd week and last 6th weeks. After 6 weeks of treatment, significant progress was recorded on Berg Balance Scale in both groups. BMI and nutritional status of the study population were also assessed. Results: The p-value of the balance error scoring system after the 6th week of treatment was (P=0.004) while at berg balance scale after the 6th week was (0.001), In group B, the p-value of the balance error scoring system after the 6th week of treatment was (P=0.001) while at berg balance scale after 6th week were (0.001), which showed significant results after 6th week of treatment. The p-value of the balance error scoring system between groups was at baseline 0.16 while after the 6th week of treatment was 0.001 and the p-value of the berg balance scale between the group was at baseline 0.764 while after the 6th week of treatment was 0.04. Both levels of the assessment indicated significant improvement in-between groups. In control group A (p=0.004) however, in the experimental group (p= &lt;0.001), BESS also showed substantial development in both the experimental and control group with p-value (p&lt;0.001) for each group. The results of the study population suggest that there is a strong relationship between obesity and stroke. Conclusion: This study evaluated that task-oriented balance training with sensory input indicated more progress in balance coordination and postural stability as compared to task-oriented balance exercises without sensory integration in patients with stroke Keywords: BMI, Postural Stability, Rehabilitation, Stroke

Effects of Balance Training Using Action Songs on Postural Control and Muscle Strength in Preschool Children

Postural control and muscle strength are important factors for the performance of everyday activities and reduce the possibility of fall-related injuries. The purpose of this study was to investigate the efficacy of a balance training program using action songs on balance and strength of preschool children. A total of 51 preschool children were randomly divided into an intervention group (25 children) and a control group (26 children). The intervention group received a balance training program with action songs (six weeks, two times a week, total 12 sessions), while the control group followed the normal curriculum. Prior to and after the intervention, both groups were assessed in dynamic balance (walking on balance beams), static balance (single-leg stance on forceplate and Flamingo test) and strength (long jump and handgrip). The results showed that the intervention group performed significantly better in the dynamic balance and Flamingo test. There were no significant differences in the centre of pressure (CoP) displacement in the Medio-Lateral direction (CoP/ML), the Anterio-Posterior (CoP/AP), and the strength variables. The reliability of the single-leg test on the forceplate was moderate. Moreover, there were no correlations between balance and muscle strength variables. It can be concluded that the balance training program with action songs constitutes an effective activity for developing preschool children’s balance, but not strength. Perhaps balance and muscle strength are independent of each other and may have to be trained with complementary activities. Moreover, the results of the study and the behaviour of the children during the one-leg stance test on the forceplate gave rise to questions regarding the appropriateness of this test for preschool children.

Effects of Balance Training on Postural Control in Athletes with Chronic Ankle Instability: A Systematic Review

Effects of Balance Training on Postural Control in Athletes with Chronic Ankle Instability: A Systematic Review

Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

Virtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR). The primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes. We randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters. We found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p≤0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p=0.022): post-hoc analysis revealed within-group differences in the EG (p=0.002) but not CG (p=0.834). We found no significant between-group differences in other outcomes. Balance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG. GOV: NCT03454256.

The Effect of Balance and Concentration Exercises on the Shooting Results of Petanque Riau Athletes

This study aimed to determine and analyze the effect of balance training on shooting results in Riau petanque athletes and the effect of concentration training on shooting results in Riau petanque athletes and investigating the effect of balance training and concentration training on shooting results in Riau petanque athletes. This study uses a quasi-experimental method with the research design "Two Group Pretest Posttest Design". The instrument used to test the shooting ability is the number game shooting station 1, 2, 3, 4, and 5 with a distance of 6 meters, 7 meters, and 8 meters. , and 9 meters. The subjects in this study were Riau Petanque athletes, totalling 32 sons, which were taken from the total sampling results. The results of this study: 1) There is an effect of balance training exercises on the shooting results of the Riau Petanque athletes. 2) there is an effect of concentration training on the shooting results of the Riau Petanque athletes. 3) there is an influence between balance training and concentration training on the shooting results of Riau petanque athletes. Based on the results of this study, it can be concluded that balance and concentration training significantly affect the shooting results of the Riau Petanque athletes based on the paired samples test. Then from the two exercises, the concentration exercise is better than the balancing exercise, based on the independent samples test. It can be interpreted that balance and concentration training influence the shooting results of the Riau Petanque athletes. Still, concentration exercises have.

No sex-specific effects of balance training on dynamic balance performance in healthy children.

Cross-sectional studies in children reported better balance performance for girls than for boys. Thus, balance trainability might be different between female and male children. The aim of the present study was to examine the effects of balance training (BT) on dynamic balance performance in girls compared to boys. Seventeen girls (age: 11.1 ± 0.7 years) and 22 boys (age: 11.1 ± 0.8 years) were assigned to either a BT-group or an active control (CON) group. BT was conducted over eight weeks (two sessions/week) while the CON-groups received their regular physical education lessons during the same period. Before and after treatment, dynamic balance performance was assessed by using the Lower Quarter Y-Balance (YBT-LQ) test. A series of three-way analyses of covariance (ANCOVA) were undertaken to test for within-between effects of Test [×2 (pretest vs. posttest)], Group [×2 (BT-group vs. CON-group)] and Sex [×2 (boys vs. girls)]. The three-way ANCOVA yielded a significant main effect of Test (p = 0.002-0.043, = 0.122-0.262) and of Group (all p < 0.001, = 0.330-0.651) but not of sex for all YBT-LQ reach directions and the composite score. Further, there were significant Test × Group interactions (all p < 0.001, = 0.330-0.651) in favor of both BT-groups but neither Test × Sex nor Test × Group × Sex interactions were detected. We conclude that BT is an effective treatment to improve dynamic balance performance in healthy children regardless of their sex. Consequently, girls and boys can be provided with the same BT regime to enhance their postural control.

Impact of Balance Training on Fear of Falling and Fall Rate in Older Women

Background: Fear of falling is one of the factors that threaten the quality of life in old age and increases the risk of falling by limiting physical activity. The purpose of this study was to investigate the effect of balance training on the efficacy of fear of falling and the rate of falling in older women. Methods: In this randomized controlled trial, 70 aging women with a fear of falling were selected and randomly assigned to experimental (n=35) and control (n=35) groups. The intervention group received 10 sessions of 1-hour balance exercise, along with training in falling prevention strategies, but the control group received only routine care. Data were collected using the Falls Efficacy Scale-International questionnaire and the new elderly health services package of the Ministry of Health of Iran. Fear of falling was evaluated as the primary outcome 1 month and 3 months after balance training, and frequency of falling was assessed as a secondary outcome one year after the intervention. Data were analyzed by ANOVA, independent t test, and paired t test. Results: The results showed that the mean score of fear of falling in the experimental group was significantly lower than in the control group 1 month (P = 0.005) and 3 months (P &lt; 0.001) after balance training. The mean score of fear of falling in the control group represented no significant difference between the three times (P = 0.64). Finally, one year after the balance training, the frequency of falling in the experimental group was significantly lower in comparison to the control group (P = 0.035). Conclusion: A balance training program is recommended as a preventive approach for reducing the frequency of falling in older women.

Balance Training Modulates Cortical Inhibition in Individuals with Parkinson’s Disease: A Randomized Controlled Trial

Background Most individuals with Parkinson’s disease (PD) develop balance dysfunction. Previous studies showed that individuals with PD have abnormal corticomotor changes related to severity of motor symptoms and disease progression. Cortical disinhibition was observed in PD and this alteration can be an early sign of PD. Balance training seems to be an effective intervention to improve balance in individuals with PD. However, it is not much known about the effect of balance training on cortical neuroplasticity in PD population. Objective To investigate the effects of balance training on corticomotor excitability in individuals with PD. Methods Twenty-eight PD participants were recruited and randomly assigned to either the balance training (BT) or the control (CON) group. Both groups underwent 16 training sessions over 8 weeks. Outcome measures for corticomotor inhibition included the cortical silent period (CSP) and short-interval intracortical inhibition (SICI) on transcranial magnetic stimulation. Balance performance was measured using the Mini-Balance Evaluation Systems Test (Mini-BEST) and the Timed Up and Go (TUG) test. Results Participants in the BT group showed a significant increase in corticomotor inhibition (CSP: P = .028, SICI: P = .04) and a significant improvement in balance performance (Mini-BEST: P = .001, TUG: P = .04) after training. Compared to the CON group, the BT group showed a greater increase in corticomotor inhibition (CSP: P = .017, SICI: P = .046) and better improvement in balance (Mini-BEST: P = .046). Conclusion Balance training could modulate corticomotor inhibition in the primary motor cortex and improve balance performance in individuals with PD.

Efficacy of lateral truncal tilt training with a wedge on postural vertical and activities of daily living in recovery phase after stroke: A randomized crossover trial.

The subjective postural vertical (SPV) is affected by training that requires participants to maintain balance; training to achieve sitting balance may also help SPV recovery and activities of daily living (ADLs). This study aimed to assess the medium-term effects of balance training on the postural vertical (PV) and ADLs in patients with stroke. Thirty-three patients with stroke were enrolled in this randomized crossover trial. The outcomes were SPV, SPV with eyes opened (SPV-EO), and the Functional Independent Measure (FIM) after the 14-day intervention of experimental or control training. Experimental training consisted of a maximum lateral truncal tilt to the paretic side at 0.25 Hz with or without a 10° wedge, repeated 60 times. Repeated-measures two-way analysis of variance was performed with two factors: intervention and the intervention period. There was no interaction between the control condition and the PV, but there was interaction between the intervention period and using a wedge for SPV variability errors. FIM showed an interaction between the intervention period and the use of a wedge. Balance training while sitting with a wedge significantly improved the SPV and FIM. This improved cognition and perception, which facilitate difficult dynamic tasks in ADLs.

Improvement in gait stability in older adults after ten sessions of standing balance training.

Balance training aims to improve balance and transfer acquired skills to real-life tasks. How older adults adapt gait to different conditions, and whether these adaptations are altered by balance training, remains unclear. We hypothesized that reorganization of modular control of muscle activity is a mechanism underlying adaptation of gait to training and environmental constraints. We investigated the transfer of standing balance training, shown to enhance unipedal balance control, to gait and adaptations in neuromuscular control of gait between normal and narrow-base walking in twenty-two older adults (72.6 ± 4.2 years). At baseline, after one, and after ten training sessions, kinematics and EMG of normal and narrow-base treadmill walking were measured. Gait parameters and temporal activation profiles of five muscle synergies were compared between time-points and gait conditions. Effects of balance training and an interaction between training and gait condition on step width were found, but not on synergies. After ten training sessions step width decreased in narrow-base walking, while step width variability decreased in both conditions. Trunk center of mass displacement and velocity, and the local divergence exponent, were lower in narrow-base compared to normal walking. Activation duration in narrow-base compared to normal walking was shorter for synergies associated with dominant leg weight acceptance and non-dominant leg stance, and longer for the synergy associated with non-dominant heel-strike. Time of peak activation associated with dominant leg stance occurred earlier in narrow-base compared to normal walking, while it was delayed in synergies associated with heel-strikes and non-dominant leg stance. The adaptations of synergies to narrow-base walking may be interpreted as related to more cautious weight transfer to the new stance leg and enhanced control over center of mass movement in the stance phase. The improvement of gait stability due to standing balance training is promising for less mobile older adults.

The Effect of Balance Training on Functional Outcomes in Patients with Knee Osteoarthritis: A Systematic Review.

Background: Knee osteoarthritis (OA) is a common musculoskeletal disorder that is associated with balance impairment. Recent studies have used balance exercises for improvement of balance and functional performance among knee OA patients. The purpose of this study was analyzing the effects of balance training in patients with knee OA. Methods: This review included clinical trials in which the effect of balance training on functional measures was assessed compared to other physiotherapy interventions or control groups in patients with knee OA. To this aim, Electronic databases (PubMed, SCOPUS, EMBASE, PEDro, CINAHL, and WOS) were searched from 1 January 1990 to 30 June 2021. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the studies. Results: Fifteen articles of clinical trials were eligible to include in this review. Most studies used patient-reported outcome measures, and some studies used performance-based functional outcome measures for the evaluation of functional outcomes. The findings of studies showed that physical function in knee OA patients could have clinical improvements significantly after receiving balance training. However, studies assessing the effect of balance training on muscle strength of the quadriceps and the hamstring had conflicting results. Also, the finding of studies showed that more significant improvement in postural stability and balance in the balance training group rather than the control group. Conclusion: The results of the current systematic review demonstrate balance exercises significantly improve balance and functionality in knee OA patients. However, the effect of balance training on muscle strength was not clearly revealed due to few studies.

The effect of balance training using visual information on the trunk control, balance and gait ability in patients with subacute stroke: Randomized controlled trial

The effect of balance training using visual information on the trunk control, balance and gait ability in patients with subacute stroke: Randomized controlled trial

Efficacy of balance training on balance performance in obese patients undergoing sleeve gastrectomy

Background: The goal of this study was to investigate the effect of balance training on balance performance in obese patients undergoing sleeve gastrectomy. Study Design: in the current study the participants will be selected from the police hospital Subjects &amp; Methods: Sixty patients who had sleeve gastrectomy were randomly divided into two equal groups. interventions. Group (A) received a program of balance training programs Periodic exercises were frequently performed for 45 min without rest among workouts with routine physical therapy program post abdominal surgical (breathing exercise, cough, and regular exercise). for three days per week for four weeks. Group (B): who takes sleeve gastrectomy with routine physical therapy program post abdominal surgery (breathing exercise, cough, and regular exercise). Main outcome measure: visual analog scale (VAS) and the Biodex Balance System (BBS). Results: Comparing both groups post- program revealed a statistically significant reduction in pain and increase in the Medio lateral stability index, anteroposterior stability index, and overall stability index in standing in both legs, on standing in RT leg only and standing in the left leg only. . All statistical measures were carried out using the statistical program for social sciences (SPSS) with version 27.