Functional Balance Training Research Articles

Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community

BackgroundsFalls affect a significant number of older Australians and present a major challenge to health care providers and health systems with over 380 older Australians hospitalised for a fall each day. ObjectivesThis statement seeks to inform and guide exercise practitioners and health professionals in safe and effective prescription of exercise to prevent falls amongst community-dwelling older people. Exercise prescription to prevent fallsExercise is crucial for preventing falls in older age. Research evidence has identified that programmes which include functional balance and muscle strength training are the most effective in preventing falls. It is also important for exercise to be progressively challenging, ongoing and of sufficient dose to maximise its benefits in reducing falls. Additional (non-exercise) interventions are necessary for people with complex medical conditions, recent hospitalisation and/or particular risk factors not improved by exercise. People at a higher risk of falls may need greater support to undertake safe and effective fall prevention exercise. SummaryGlobal guidelines for fall prevention and management recommend that all older adults should receive advice about exercise to prevent falls. Qualified exercise professionals are well placed to prescribe and supervise functional balance and muscle strength training to older people with varied functional abilities, including those with co-morbidities.

Effectiveness of Functional Strength Training and Balance Training on Postural Stability and Gait in Patients with Diabetic Peripheral Neuropathy to Reduce the Risk of Falls

BACKGROUND: Diabetic peripheral Neuropathy (DPN) is one of the most common chronic complications of diabetes mellitus, mainly affects lower limbs in patients with diabetes. It may lead to distressing and expensive clinical sequelae like impairments in tactile sensitivity, vibration sense, lower limb proprioception, and kinesthesia. This lead to the increased risk of falls. Thus, taking into consideration, the debilitating effects of diabetic neuropathy, Functional strength training (ST) and Balance training is advocated for these individuals to prevent further deterioration AIM: The objective of this study was to study the effectiveness of functional ST and balance training on Postural stability and gait in patients with diabetic neuropathy. Methodology: This study was an experimental study and type of sampling was convenient sampling. The Sample size taken was 20 and the place of the study conducted was physiotherapy OPD. Results: The results were obtained using BBS, DGI and ABC scale on the basis of pre and post treatment data were collected. Statistical Analysis shows the positive effectiveness of Functional strength training and balance training on reducing the risk of falls in Diabetic peripheral neuropathy Conclusion: Functional strength training and Balance training can be included as a part of treatment for patients with Diabetic peripheral neuropathy. Keywords: Diabetic peripheral neuropathy, Functional strength training, Balance

Functional balance training in people with Parkinson's disease: a protocol of balanceHOME randomized control trial with crossover.

Balance disturbances in Parkinson's Disease (PD) are usually assessed in a single-task as well as standard balance physiotherapy is carried out in isolated environments. Conversely, daily activities are developed in highly challenging environments. Although functional balance training (FBT) is included in the latest protocols, several methodological issues have not yet been considered. In the proposed single-blinded randomized control trial with crossover (NCT04963894), the aims are (1) to quantify the effects achieved by domiciliary FBT (balanceHOME program) in participants with and without cognitive impairment, and (2) to compare them with the effects of a passive-control period and a conventional face-to-face physiotherapy program for PD. The initial recruitment was estimated at 112 people with idiopathic PD. Two-thirds of the participants will be randomized to one of the two groups to make the crossover. In contrast, the other third will do a face-to-face group program only. The balanceHOME protocol consists of challenging balance exercises incorporated into functional daily tasks, developed in-home and conducted two times per week for 60-min over an 8-weeks period. The primary strategy will consist of splitting functional tasks of daily life into static and dynamic balance components, besides standardized facilitate and disturbing strategies to execution of each exercise. Biomechanics and clinical performance of balance and gait, perception of quality of life, cognitive and mental functioning, and severity of PD will be measured at baseline (T0), post-8 weeks training (T1), and follow-up (T2). The primary outcome of the study will be the center of pressure sway area. The secondary outcomes consist of biomechanics and clinical variables related to static and dynamic balance. Outcomes from biomechanical of gait, quality of life, cognitive and mental state, and severity of PD, represent the tertiary outcomes. The balanceHOME program standardizes the FBT in demanding and daily environments for people with PD who prefer individualized treatment from home. This is the first time that the effects of group versus individual balance rehabilitation have been compared in people with and without cognitive impairment and evaluated in complex environments. This still-to-be-finished study will open the possibility of new strategies according to changes in post-pandemic therapeutic approaches.

Effects of Cognitive Training in Flanker Task on Mobility of Older Adults: A Randomized Controlled Trail

Introduction: Cognitive function is considered to be correlated with the older adults’ mobility. Flanker task, reflecting the conflict resolution, is barely explored as a simple approach to train the older adults’ cognitive function. Hence, the first aim of this study was to explore the effect of cognitive intervention adopting flanker task on mobility. The second aim of this study was to assess the effect of cognitive training by comparing it with physical training to disclose how much dosage of cognitive training can have the equal improvement of mobility with physical training. Methods: 232 older adults (age, mean ± SD: 66.16 ± 7.08, female: 74.3%) were retrained and assigned into three groups (cognitive intervention group, physical exercise intervention group, and control group). The intervention lasted for 22 weeks (cognitive intervention: flanker task, 30 min per session, 3 sessions a week; physical exercise intervention: 30 min muscle and balance training session, twice a week, and 30 min daily walking and housework, 2–4 times a week). Grip strength, 30-s chair-stand test, single leg balance with eyes closed, and the timed “Up & Go” (TUG) were used as indicators of mobility. A mixed model analysis of variance (ANOVA), interaction effect, and simple effect were performed in statistical analysis. Results: Both intervention groups improved mobility, and the results were similar behaviorally. However, the exercise intervention group performed better in 30-s chair-stand test (25.14 ± 0.67 vs. 23.71 ± 0.76 with p = 0.01) and single leg balance with eyes closed (8.15 ± 0.69 vs. 6.14 ± 0.43 with p < 0.001). Conclusion: 22-week cognitive intervention (for total 1,980 min) could improve the older adults’ mobility to the similar extent of mild-to-moderate physical exercises (1,320 min of functional muscle and balance training and 1,980 daily physical activities), which ascertained the far transfer effects from cognition to untrained mobility domain and found a comparable dosage of cognitive and physical exercise training.

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.

U13 Kadın Futbolcularda Fonksiyonel Denge Antrenmanlarının Denge ve Çeviklik Performansına Etkisi: Tanımlayıcı Araştırma

Amaç: Bu çalışmanın amacı, U13 kategorisi kadın futbolcularda fonksiyonel denge antrenmanlarının denge ve çeviklik üzerindeki etkisini incelemektir. Gereç ve Yöntemler: Çalışmaya, Konak Belediyesi Spor Kulübü'nün 22 kadın futbolcusu gönüllü olarak katılmıştır. Katılımcılar, Bosu grubu ve Düz Zemin grubu olmak üzere rastgele 2 gruba ayrılmıştır [Bosu (n=11): yaş 12,45±0,52; Düz Zemin (n=11): yaş 12,09±0,94]. İki gruba 6 hafta boyunca, haftada 3 gün 35 dk rutin antrenmanlarından önce fonksiyonel denge antrenmanları uygulanmıştır. Uygulama öncesi ve sonrasında katılımcıların statik denge ölçümleri Flamingo denge testi ile dinamik denge ölçümleri Y denge testi ile çeviklik ölçümleri ise T testi kullanılarak ölçülmüştür. Grupların kendi içinde ön ve son test verileri arasındaki farklar Wilcoxon işaretli sıralar testi, gruplar arasındaki farklar için Mann-Whitney U testi kullanılmıştır. Bulgular: Fonksiyonel denge antrenmanlarından sonra Bosu grubunun sağ ayak statik denge ve sol ayak statik denge performansında gelişim görülmüştür (p<0,01, p<0,05). Bosu grubunun dinamik denge sağ ayak posteromediyal, posterolateral ve sol ayak posterolateral değerlerinde artış saptanmıştır (p<0,01). Bosu grubunun çeviklik performansı fonksiyonel denge antrenmanlarından sonra gelişmiştir (p<0,05). Düz Zemin grubunun dinamik denge ve çeviklik performansında gelişim görülmezken, sağ ayak statik denge ve sol ayak statik denge performansında artış görülmüştür (p<0,05, p<0,01). Her iki grubun son test değerleri karşılaştırıldığında, Bosu grubunun statik denge ve dinamik denge performansının Düz Zemin grubundan daha iyi olduğu saptanmıştır. Sonuç: Bosu üzerinde gerçekleştirilen fonksiyonel denge antrenmanlarının dinamik denge, statik denge ve çeviklik performansı üzerine olumlu etkileri olduğu ileri sürülebilir.

MoveStrong at home: a feasibility study of a model for remote delivery of functional strength and balance training combined with nutrition education for older pre-frail and frail adults.

Exercise and nutrition interventions are often recommended for frailty; however, effective strategies are required for real-world implementation. Our primary aim was to assess the feasibility and acceptability of telephone and virtual delivery of MoveStrong, an 8-week exercise and nutrition program with a 4-week follow-up for older pre-frail and frail adults. A priori criteria for success included: recruitment (≥25/12 weeks), retention at follow-up (≥80%), and adherence to exercise and nutrition sessions (≥70%). We recruited community-dwelling Ontario residents; ≥60 years, ≥1 chronic condition, ≥1 FRAIL scale score. Participants received mailed materials, a personalized exercise program, 11 remote one-on-one training sessions with an exercise physiologist and 3 online dietitian-led nutrition education sessions. We completed exploratory analyses of secondary outcomes including physical function and dietary protein intake. Semi-structured interviews supported program evaluation. In total, 30 participants were enrolled. 28 (93%) participants completed program and follow-up assessments. Adherence to exercise and nutrition sessions (CI) was 84% (77%-91%) and 82% (70%-93%) respectively. At program end and follow-up [mean change (CI)], significant improvements were measured in 30-second chair stand test [3.50 (1.12-5.86), 4.54 (1.94-7.13) chair stands] and dietary protein intake [12.9 (5.7-20.0), 9.2 (0.4-18.1) g]. Overall, participants were satisfied with program delivery. Trial registration number: NCT04663685.

Is Dual-Task Training Clinically Beneficial to Improve Balance and Executive Function in Community-Dwelling Older Adults with a History of Falls?

Purpose: To date, the effects of dual-task training on balance underlying cognitive function remain unclear. Therefore, this study was to verify the effects of cognitive–physical dual-task training on balance and executive function in community-dwelling older adults with a history of falls. Method: Fifty-eight participants were randomly allocated to the experimental group (EG) receiving cognitive–physical dual-task training (n = 29) or to the control group (CG) receiving functional balance training (n = 29). After 12 sessions for 6 weeks, the One Leg Standing Test (OLST), the Timed UP and Go (TUG), and part B of the Trail-Making Test (TMT-B) were implemented to examine static and dynamic balance and executive function. Results: After the 12 sessions, the EG showed a greater improvement in the OLST (p < 0.001; η2 = 0.332), the TUG (p < 0.001; η2 = 0.375), and the TMT-B (p < 0.001; η2 = 0.224) compared to the CG. Conclusion: These results indicate that dual-task training is clinically beneficial to improving static and dynamic balance as well as executive function in older adults with a history of falls. These findings shed new light on a clinical implication that executive function should be considered in balance training for older adults.

Supporting physical activity in an ageing world: a call for action

Supporting physical activity in an ageing world: a call for action

Dalfampridine for Mobility Limitations in People With Multiple Sclerosis May Be Augmented by Physical Therapy: A Non-randomized Two-Group Proof-of-Concept Pilot Study.

Purpose: To demonstrate proof-of-concept for a combined physical therapy and pharmacological intervention and obtain preliminary estimates of the therapeutic efficacy of a motor-relearning physical therapy intervention with and without concurrent dalfampridine treatment on gait speed in people with mobility limitations due to multiple sclerosis (MS).Methods: Using a non-randomized, two-group design, 4 individuals with MS newly prescribed dalfampridine as part of their routine medical care, and 4 individuals with MS not taking dalfampridine completed a 3-week drug run-in or no-treatment baseline, respectively. After 3 weeks, all participants commenced physical therapy twice weekly for 6 weeks. Participants taking dalfampridine took the medication for the study duration. The physical therapy program comprised functional strengthening, gait training, balance training, and dual-task training. The primary outcome was Timed 25-foot Walk (T25FW) at the end of the 6-week physical therapy program.Results: For the 4 participants taking dalfampridine, average improvement in T25FW on drug only was 12.8% (95% CI 1.2 to 24.4%). During the 6-week physical therapy phase, both groups significantly improved T25FW, but the effect tended to favor the group taking dalfampridine (mean difference = −0.93 s, 95% CI −1.9 to 0.07 s, p = 0.064, d = 1.6). Whereas the physical therapy group had average T25FW improvement of 10.8% (95% CI 1.0 to 20.5%), the physical therapy plus dalfampridine group demonstrated average improvement of 20.7% (95% CI 3.8 to 37.6%).Conclusions: Further research is warranted to examine whether dalfampridine for mobility impairment may be augmented by physical therapy in people with MS.

Pre- and Postoperative Rehabilitation of Craniopagus Conjoined Twins: A Case Report

Aims Describe the pre-operative and post-operative stages of physical therapy examination, rehabilitation interventions and outcomes in craniopagus conjoined twins (CCT). Methods 27-months old total vertical types III CCT were admitted for surgical treatment. A structured rehabilitation program (functional mobility, balance training, sensory stimulation, communication, orthotic management, and caregiver education) was delivered post-operatively at different stages of surgery. The total duration of post-separation rehabilitation was 15 months for Twin A and 23 months for Twin B. Results Pre-operative WeeFIM was 67/126 for both the twins. Post-separation, Twin A improved to a state of complete independence in walking, step climbing, and hand function with a discharge WeeFIM score of 84/126. However, Twin B was completely dependent in bed mobility and transfer activities during discharge (WeeFIM-18/126). Minimal change in functional status was noted in Twin B (discharge FSS score-19/30). Both the twins were transferred to a regional hospital for long-term care. At 67 months of age, Twin B lost his life due to chest infection. Conclusions Vestibular based therapies, balance, and postural control may be prioritized in the rehabilitation process of CCT. Greater communication and coordination among physical, occupational therapists and other rehabilitation professionals are recommended for successful outcome in these unique cases.

Activité physique chez l’adulte en consultation de l’ostéoporose

Physical activity is a modifiable risk factor for osteoporosis. Studies on physical activity and bone health have mainly targeted postmenopausal women. Observational studies with fracture outcomes of physical activity interventions in adults older than 40 years found 11-40 % reduced risk of any fracture. There is no randomised controlled trials of exercise with fracture as a primary outcome. However, there is evidence that exercise can reduce fall-related fractures, particularly exercise that includes functional strength and balance training. Exercise recommendations to optimize bone health emphasize moderate-intensity or high-intensity progressive resistance training (PRT), and impact (weight-bearing activities) and balance training in order to reduce falls and improve bone mineral density. Indeed, multicomponent programmes that combine impact exercise with sufficiently dosed, moderate-intensity or high-intensity PRT and that are progressive in nature are the most effective. Professionals should avoid restricting physical activity and exercise unnecessarily according to age. People with osteoporosis should be encouraged to do more rather than less. Important themes for osteoporosis are: strong, steady and straight!

Physical therapy interventions to improve sitting ability in children with or at-risk for cerebral palsy: a systematic review and meta-analysis.

To conduct a systematic review and meta-analysis on the effectiveness of physical therapy interventions to improve sitting ability in young children with or at risk for cerebral palsy (CP). A systematic literature search was performed using five databases. Study selection criteria were randomized controlled trials published in English on physical therapy interventions targeting sitting, reporting developmental or functional sitting outcomes, and focused on young children with or at risk for CP (mean age ≤5y). Risk of bias (ROB) was assessed using the Cochrane ROB 2.0 tool. Twelve unique studies met the inclusion criteria and were categorized into one of two categories: (1) comparison of two physical therapy interventions or (2) physical therapy plus adjunct versus physical therapy alone. The combined pooled effect size (g) for the 10 studies included in meta-analysis was large (g=0.78) but non-significant. Pooled effect for category 1 was small (g=-0.06) and non-significant. Interventions in category 2 showed a large and significant effect (g=1.90, p=0.022). There is a lack of strong evidence for physical therapy interventions targeting sitting in young children with or at-risk for CP due to limitations in methodological rigor and sample sizes. Components of impairment remediation combined with functional balance training should be explored to improve sitting in children diagnosed with CP. Given the benefits of early achievement of sitting, strong evidence-based research is needed. Strong evidence is lacking for physical therapy interventions to improve sitting ability in young children with/at risk for cerebral palsy (CP). Kinesio-taping may be an effective adjunct to conventional physical therapy in improving sitting ability in children with spastic bilateral CP. Task-specific, intensive, and child-initiated intervention components show promise for improving sitting in young infants at risk for CP.

Effectiveness of isolated ankle strengthening and functional balance training in single leg drop jump land in football players and measuring the stability

Introduction and Aim: Football is one of the famous sports in the world and associated with many ankle injuries in football players. Many football players use single leg drop jump landing ranging from 13 to 20 out of 1000 players. Functional balance maintain or improve activities of daily living and quality of life. Strength training increases the density of bone and reduces the risk of fractures. Aim of this present study is to analyze the effectiveness of the isolated ankle strengthening and functional balance training in single leg drop jump land in football players.&#x0D; Materials and Methods: 30 football players with single leg drop jump were randomly selected to participate in this pre and post test experimental study. Study is done at ACS medical college. Selected players were asked to perform the exercise for about 8 weeks, 40 minutes per day. The subjects performed ankle strengthening for 20 minutes and functional balance training for 20 minutes. Dorsiflexors are at high-risk injury during single leg drop jump land in football players. Thus, exercise is given for strengthening and functional balance and prevailing stability of ankle is measured using foot and ankle measure (sub scale) (FAAM), Star Excursion Balance Test (SEBT).&#x0D; Results: On comparing mean values of SEBT within group between pretest and post-test values, it shows statistically highly significant difference and improvement in balance between pre-test (89.67) and post-test (94.18) at P&lt;0.001. On comparing the mean value of FAMM sports subscale within group between pretest and post-test values, it shows statistically highly significant difference and improvement in ankle and foot physical function between pretest (45.34) and post-test (60.81) at P &lt;0.001.&#x0D; Conclusion: This study shows that isolated ankle strengthening, and functional balance training is effective in improving the ankle strength and balance in football players.&#x0D; Keywords: Stability threshold; single leg drop jump land; foot and ankle ability measure scale sports subscale (FAAM); star excursion balance test (SEBT)

Independent walking and balance in children with CHARGE syndrome

Children with CHARGE syndrome (CWCS) are born with multiple physical disabilities, several of which impair balance and the onset of motor milestones. Early motor development problems can include delayed independent walking, which has been found in CWCS. In addition, few studies have examined balance in CWCS and these studies have been limited in scope, necessitating a more comprehensive examination of balance in this population. Motor development occurs as a progression of stages as represented by Seefeldt’s conceptual model. As such, it is essential to examine the association of early development of foundational skills, such as balance, with the onset of motor milestones as they are building blocks to motor competence. The aims of this study are to (1) examine the differential effects of children with and without CHARGE syndrome on balance and (2) examine the association of age of walking to these balance measures. In this study, 27 CWCS and 22 children without CHARGE syndrome, aged 7 to 16 years, were assessed on four components of balance including anticipatory control, reactive postural control, sensory orientation, and dynamic gait using the shortened version of the Balance Evaluation Systems Test (mini-BESTest) and parental reported age of independent walking. Their balance and age of walking were compared to 22 typically developing peers of similar age and gender distribution. Results revealed that CWCS walked three times later than their peers without CHARGE syndrome and had significant deficits on all balance systems assessed with the largest difference occurring in anticipatory control. Anticipatory control is critically important in maintaining static and dynamic postural control. These results indicate a critical need for early functional balance training and compensatory strategies in CWCS.

Electroskip auditory biofeedback in a patient with Parkinson disease: a case report.

The purpose of this case study was to observe the effects of a rehabilitation program with an audio-biofeedback technology device called Electroskip in a patient with Parkinson disease. The patient was a 61-year-old man with moderate Parkinson disease (Hoehn and Yahr Parkinson’s scale stage III) and dementia who had progressive episodes of freezing of gait. The patient also had a history of recent falls. The patient completed a 6-week rehabilitation program focused on functional tasks, balance and gait training while using Electroskip technology, which is a wireless, wearable device that sends a discrete real-time generative audio-biofeedback signal when the user steps on either the heel or toe force sensors positioned under the innersoles. The outcome measures included the Timed Up and Go test, the modified Gait Abnormality Rating Scale, the modified Parkinson’s Activity Scale, and the Freezing of Gait Questionnaire. The patient completed 17 of the 18 scheduled training sessions and all testing sessions; no adverse events occurred during the rehabilitation program and high satisfaction levels were reported by the patient and family after completion of the 6-week rehabilitation program. Clinically significant improvements were seen in all measures at 6 weeks. The results of this report suggest that a rehabilitation program focused on functional tasks, balance, and gait training using the Electroskip technology may be beneficial for improving gait and balance in a patient with moderate Parkinson disease. Future work is needed to determine the effectiveness of Electroskip technology by means of randomized controlled trials.

Which is efficient in improving postural control among the novice runners? Isolated ankle strengthening or functional balance training programme: A randomized controlled trial

Background: Functional balance is the integration of static and dynamic balance training to maintain or improve activities of daily living and quality of life. But, there is a lack of study examining effects of functional balance training programme (FTP) on novice runners. Objective: To compare the effects of isolated ankle strengthening exercise (IASE) and FTP in improving postural control among the novice runners. Materials and methods: A total of 30 novice runners were recruited by the simple random sampling (random number generator) to participate in this two group pretest-posttest, single blinded randomized controlled study. Recruited subjects were randomly divided into two groups, group A and group B. The novice runners in group A received, IASE. While in group B, the runners received FTP. Both the group performed the prescribed exercised for 4 weeks (5 days/week, a total of 20 sessions). Baseline and post exercise changes after 4 weeks were documented by star excursion balance test (SEBT) and foot and ankle ability measure (FAAM) and analyzed. Results: Group B demonstrated significance difference (p<0.05) in SEBT and FAAM when compared to group A. Conclusion: FTP is more beneficial in improving postural control and thereby could have the potential to reduce risk of injury when compared to IASE among the novice runners.

Does balance training balance the functional aspects of ankle instability?

Background and Purpose: Ankle sprains are the reigning top most priority in the management and prevention of sports injuries. However, the repetitive nature of the injury makes it difficult to prevent as the functional deficits disturb the kinesthetic sense and thereby functional movement performance indicators of sportsmen. Balance training is considered as the mainstay of preventive strategy for ankle sprains though limited evidence seems to suggest the actual mode of training. This study was aimed to study the efficacy of wobble board training and a new functional balance training program on athletes with recurrent ankle sprains and reported functional deficits in the injured or affected leg. Materials and Methods : The training was carried out for 30 recreational athletes with a history of giving away and atleast 1 ankle sprain during the past 6months. Static and dynamic postural control were assessed using measures of balance in static and dynamic mode. Results: The results of the study showed that both training programs showed equal benefits in improving the static and dynamic postural control though functional training had more impact due to its functional nature of movements. Conclusion: The findings from our study pointed toward the greater need to involve function oriented movement approach to prevent sporting injuries as frequent and common as ankle sprains.

A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol.

BackgroundFalls amongst people with Parkinson’s (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population.The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP.Methods/DesignA UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible.The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care.Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants.The primary outcome is risk of repeat falling at six months post-randomisation.DiscussionThe aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches.Trial registrationCurrent Controlled Trials ISRCTN48152791

The effects of isolated ankle strengthening and functional balance training on strength, running mechanics, postural control and injury prevention in novice runners: design of a randomized controlled trial.

BackgroundRisk factors have been proposed for running injuries including (a) reduced muscular strength, (b) excessive joint movements and (c) excessive joint moments in the frontal and transverse planes. To date, many running injury prevention programs have focused on a “top down” approach to strengthen the hip musculature in the attempt to reduce movements and moments at the hip, knee, and/or ankle joints. However, running mechanics did not change when hip muscle strength increased. It could be speculated that emphasis should be placed on increasing the strength of the ankle joint for a “ground up” approach. Strengthening of the large and small muscles crossing the ankle joint is assumed to change the force distribution for these muscles and to increase the use of smaller muscles. This would be associated with a reduction of joint and insertion forces, which could have a beneficial effect on injury prevention. However, training of the ankle joint as an injury prevention strategy has not been studied. Ankle strengthening techniques include isolated strengthening or movement-related strengthening such as functional balance training. There is little knowledge about the efficacy of such training programs on strength alteration, gait or injury reduction.Methods/DesignNovice runners will be randomly assigned to one of three groups: an isolated ankle strengthening group (strength, n = 40), a functional balance training group (balance, n = 40) or an activity-matched control group (control, n = 40). Isokinetic strength will be measured using a Biodex System 3 dynamometer. Running kinematics and kinetics will be assessed using 3D motion analysis and a force platform. Postural control will be assessed by quantifying the magnitude and temporal structure of the center of pressure trace during single leg stance on a force platform. The change pre- and post-training in isokinetic strength, running mechanics, and postural control variables will be compared following the interventions. Injuries rates will be compared between groups over 6 months.DiscussionAvoiding injury will allow individuals to enjoy the benefits of participating in aerobic activities and reduce the healthcare costs associated with running injuries.Trial registrationCurrent Controlled TrialNCT01900262.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-407) contains supplementary material, which is available to authorized users.