Prevention Exercise Program Research Articles

ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial.

BackgroundFalls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people.Methods/DesignThis international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars.DiscussionWe hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home.Trial registrationAustralian New Zealand Clinical Trials Registry Trial ID: ACTRN12614000096651.International Standard Randomised Controlled Trial Number: ISRCTN15932647.

Acute exercise effects on balance outcome measures in healthy older adults: Preliminary results

Approximately one third of Canadian seniors experience a fall each year and one quarter suffer serious injuries as a result. Preventative exercise programs are commonly recommended; however, the current methods used to assess the risk associated with these programs do not include the effects of exercise on fall risk. The purpose of this study was to determine the effects of acute exercise on balance in elderly individuals. We hypothesized that acute exercise in healthy seniors would negatively affect balance outcome measures in those seniors who had a prior history of at least one fall in the past year. During the study participants were separated into two groups: those who had experienced a fall in the last year (fallers) and those who had not (non-fallers). All participants underwent static and dynamic tests to determine balance outcome measures under fatigued and control (non-fatigued) conditions. To represent the fatigued condition, the Naughton treadmill protocol was used to safely increase heart rate to 60-69% HRmax. Although it was expected that performance in the balance outcome measures would be adversely affected by the acute exercise bout in patients at a high risk of falling, conclusive results could not be drawn as the data collected were all from participants who had not experienced a fall within the past year. However, preliminary results are presented for data collected from six participants classified as non-fallers.
 
 Keywords: acute exercise; balance; fall risk; older adults

When 'just doing it' is not enough: assessing the fidelity of player performance of an injury prevention exercise program.

To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Observational. The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. The raters agreed on 61/70 observations (87%) (Kappa=0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.

A systematic review of core implementation components in team ball sport injury prevention trials

BackgroundRecently, the use of specific exercise programmes to prevent musculoskeletal injuries in team ball sports has gained considerable attention, and the results of large-scale, randomised controlled trials have supported their...

THE IMPLEMENTATION OF TEAM BALL SPORT INJURY PREVENTION EXERCISE PROGRAMMES: A SYSTEMATIC REVIEW EMPLOYING THE RE-AIM FRAMEWORK

BackgroundRecent published studies on injury prevention exercise programmes (IPEPs) in team ball sports support the protective effect of these interventions, but also highlight that achieving adequate compliance is challenging. A...

Präventive Bewegungstherapie reduziert bei Senioren die Zahl sturzbedingter Verletzungen

Referat zur Arbeit von El-Khoury F, Cassou B, Charles M-A Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013; 347: f6234

Long-Term Participation in Peer-Led Fall Prevention Classes Predicts Lower Fall Incidence

ObjectiveTo investigate the association between length of participation in Steady As You Go (SAYGO) peer-led fall prevention exercise classes for older adults and 12-month fall incidence. DesignTwelve-month prospective cohort study. SettingCommunity settings. ParticipantsOlder adults (N=207; 189 women, 18 men) aged ≥65y (mean age ± SD, 77.7±6.6y) actively participating in SAYGO classes. InterventionPeer-led fall prevention exercise classes. Main Outcome MeasuresTwelve-month prospective fall incidence data were collected by monthly calendars. Falls in the previous year and number of years of SAYGO participation were obtained by baseline questionnaire. Class attendance was monitored weekly by class attendance records. ResultsMean length ± SD of SAYGO participation was 4.3±2.5 years (range, 1–10y). Average class attendance was 69%. Crude fall rate was .75 per person-year. Fall incidences at 12 and 24 months were highly correlated (r=.897, P<.001). Longer SAYGO participation (≥3y) resulted in a lower 12-month fall incidence (incidence rate ratio, .90; 95% confidence interval, .82–.99; P=.03) compared with a shorter duration of participation (1–2y). ConclusionsSAYGO appears to be an effective fall prevention intervention with a high attendance rate and a lower fall incidence with long-term participation. Prospective controlled studies on long-term participation in peer-led fall prevention exercise programs are needed to confirm and extend these findings.

A community-based Falls Management Exercise Programme (FaME) improves balance, walking speed and reduced fear of falling

Although effective community falls prevention programmes for the older persons have been described, challenges remain in translating proven interventions into daily practice. To evaluate the efficacy, feasibility and acceptability of a falls prevention programme that can be integrated into daily activities in a group of community-dwelling older adults with risk of falling. A cohort study with intervention and comparison groups was designed to evaluate a 36-week group-based falls prevention exercise programme (FaME) in the community setting. Participants were aged 60 years or older, had fallen in the past 12 months, had fear of falling with avoidance of activities or had deficits in balance control. Primary outcome measures included assessment of balance control and mobility; secondary outcome measures included level of physical activity, assessment of fear of falling and health-related quality of life. There were 48 and 51 participants in the intervention and comparison groups, respectively. There were improvements in measurements of balance, walking speed and self-efficacy. The drop out rate was low (14.6% and 3.9% from the intervention and comparison groups, respectively). Overall compliance in the intervention group was 79%. Factors that motivated continued participation include the regular and long-term nature of the programme helping to reinforce their exercise habits, the simplicity of movements and friendliness of the group. The FaME programme improves balance, walking speed and reduces fear of falling. It could be widely promoted and integrated into regular health and social activities in community settings.

Effects of a Community-based Fall Prevention Exercise Program on Activity Participation.

This study was conducted to identify the effects of a fall-prevention exercise program on the participation and static balance of elderly persons in daily life roles. [Subjects] Ten participants over 65 years of age (75.29±2.93) who were healthy community-dwellers (two men and eight women) were recruited. [Methods] The participants exercised three times a week for eight weeks. The exercise program was based on the fitness and mobility exercise (FAME) protocol. The outcome measures were changes in activity participation level and the fall index. [Results] After the exercise, the activity participation level significantly increased, and the fall index significantly decreased. [Conclusion] A fall prevention exercise program can have a positive effect on participation and static balance in older adults.

Effects of a Fall Prevention Exercise Program on Muscle Strength and Balance of the Old-old Elderly.

[Purpose] The purpose of this study was to investigate the effects of an 8-week balance exercise and elastic-resistance exercise program on muscle strength and balance of the old-old elderly (over the age of 75). [Subjects and Methods] Fifty-five elderly persons were recruited from the community and assigned to three groups for convenience: balance exercise (intervention group 1; INT 1), resistance exercise (intervention group 2; INT 2), and control (CON) groups. The intervention was performed twice a week at a senior center and three times a week at home for 8 weeks. Muscle strength and balance were evaluated before and at the end of the trial, using a PowertrackIIand Tetrax. [Results] There were significant improvements in the strength of all seven muscle groups and balance in the INT 2 group. In the INT 1 group, there were significant improvements in the strength of all muscle groups except for the knee flexor and ankle plantar flexor muscle groups. [Conclusion] This study demonstrated that an intervention using balance exercises or elastic-resistance exercises is effective at improving the muscle strength and balance of the old-old elderly. These type of exercises should be appropriate for the physical characteristics of the subjects.

A national survey of services for bone health and falls prevention exercise programmes in primary care in Ireland

BACKGROUND: In order to develop the necessary falls and fracture prevention strategies a review of current services is required. METHODS: All 32 Primary Care Local Health Offices (LHO) in Ireland were surveyed. AIMS: To profile physiotherapy-led bone health and falls prevention services operating within the primary care structure in Ireland. RESULTS: Seventy nine per cent (n = 23) of LHOs had at least one programme operating managed in all cases by senior physiotherapists. Falls prevention programmes (72%) were most prevalent while (35%) of programmes targeted bone health. General Practitioners (87.5%) were the most common referral source and prior fall the principal referral reason. A majority of programme participants were in the 70–80 year age range. Exercise components reflected clinical guidelines, focusing on balance and strength training. Interventions were modelled on the Otago (50%), Later Life Training / FaME (29%) programmes. The absence of client follow-up post programme for measurement of falls or fracture incidence or health service utilisation was notable. Barriers to programme development included inappropriate venues, lack of patient transport, financial and staffing restraints. CONCLUSIONS: Most LHOs provided some form of evidence-based programme however it is unlikely that current service levels meet population needs. Barriers to service expansion were identified.

Changes in the physical functions of pre-frail elderly women after participation in a 1-year preventative exercise program

The present study clarifies the effects of participation in a preventative health classroom program (exercise program) for 1 year on the physical functions of pre-frail elderly individuals in comparison with healthy elderly individuals. Participants in the study included 28 elderly pre-frail female participants and 28 elderly healthy female participants. Participants engaged in the exercise program for 1 year. There was no significant age or physical differences between both groups. Before and after the exercise program, the following physical function tests were carried out: grip strength, one-legged balance with eyes open, 5-m walking time and a timed up & go (TUG). The pre-frail elderly group tested significantly lower in the one-legged balance with eyes open test and the TUG test compared with the healthy elderly group. The 5-m walking time test improved significantly in both groups, but the TUG improved only in the pre-frail elderly group. Conversely, the grip strength and one-legged balance with eyes open tests remained unchanged. Improvements in the TUG and 5-m walking time tests were found in the pre-frail elderly group after the 1-year exercise program. Their results in the TUG test might be greater than those among the healthy elderly individuals.

A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial

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

Strategies to reduce long‐term postchemoradiation dysphagia in patients with head and neck cancer: An evidence‐based review

Swallowing dysfunction following chemoradiation for head and neck cancer is a major cause of morbidity and reduced quality of life. This review discusses 3 strategies that may improve posttreatment swallowing function. The literature was assessed by a multiauthor team that produced evidence-based recommendations. (1) Prospective and randomized studies with small cohorts show a trend toward benefits for a preventative exercise program addressing oral and pharyngeal structures. (2) Prospective and retrospective data indicate that better swallowing outcomes are likely when nasogastric tubes are used in preference to gastrostomy tubes to supplement enteral nutrition during chemoradiation. (3) Emerging prospective data with mature results on small cohorts support the hypothesis that radiation dose restriction to swallowing structures using intensity-modulated radiation therapy techniques leads to better swallow outcomes. This study discusses 3 strategies for improving swallow-related outcomes in patients undergoing chemoradiation for head and neck cancer and identifies areas for future research.

Basketball coaches' utilization of ankle injury prevention strategies.

Background:Ankle injuries are the most common high school basketball injury. Little is known regarding the utilization of ankle injury prevention strategies in high school settings.Objective:To determine high school basketball coaches’ utilization of ankle injury prevention strategies, including prophylactic ankle bracing (PAB) or an ankle injury prevention exercise program (AIEPP).Study Design:Cross-sectional survey.Methods:The survey was distributed to all high school basketball coaches in Wisconsin. Fisher exact and Wilcoxon rank sum tests were used to determine if the injury prevention strategies utilized differed according to school size, sex of the team, years of coaching experience, and the coach’s education level.Results:Four hundred eighty (55%) coaches from 299 (74%) high schools completed the survey. Thirty-seven percent of the coaches encouraged or required their players to use PAB. School enrollment of the coaches’ teams did not affect their stance on the use of PAB (P = 0.30), neither did the sex of the team (P = 0.16), years coaching (P = 0.09), nor the coach’s education (P = 0.49). Fifty percent (n = 242) of the coaches indicated they do not utilize an AIEPP, with no difference based on school enrollment (P = 0.47), team sex (P = 0.41), years coaching (P = 0.78), or the education level (P = 0.44). Barriers to utilization of AIEPP included a lack of time, awareness, and expertise. Coaches preferred an AIEPP that was specific to basketball, combined injury prevention and performance enhancement components, was performed 2 to 3 days per week, and lasted 5 to 15 minutes.Conclusion:Less than half of the coaches encouraged use of PAB, and half did not utilize an AIEPP. Coaches had specific preferences for the type of AIEPP they would implement.Clinical Relevance:Sports medicine providers should promote ankle injury prevention strategies but need to address why prevention strategies may not be utilized in high school basketball settings.

Barriers and motivators to exercise for older adults: A focus on those living in rural and remote areas of Australia

To identify the barriers and facilitators for exercise in older adults (50 years or over) specific to those living in rural and remote areas in Australia and to identify how this relates to falls prevention exercise programs in these areas. Literature review. Search of the databases of Medline, Scopus and Social Sciences Citation Index. Rural and remote areas. Searching identified 56 articles relating to barriers or facilitators to exercise in older adults in general, of which 25 are discussed in the article. Five of these articles specifically related to rural and remote areas, of which all were from studies in the United States. No literature specifically relating to rural and remote Australia was identified. Therefore, articles included in the final review were from three different domains - world literature (excluding those specific to rural and remote areas of Australia), rural and remote literature (note not Australian), and Australian literature to enable a comparison between the different populations to occur. There are similarities and differences between the barriers and facilitators in various populations, and no one factor alone will enable exercise in older adults. Research needs to be conducted on the barriers and facilitators to exercise in older adults living in rural and remote areas in Australia. Falls prevention exercise programs need to be tailored to suit the unique needs of the rural and remote older population.

Falls and fractures in participants and excluded non‐participants of a fall prevention exercise program for elderly women with a history of falls: 1‐year follow‐up study

To evaluate the effectiveness of a strength and balance enhancing exercise intervention as a means of preventing falls in community-dwelling elderly Japanese women with a history of falls, while comparing functional fitness, fall and fracture rate in excluded subjects. A 1-year follow-up trial was carried out on 105 participants over the age of 70 years, who were randomly assigned to the exercise or education group, and also on 91 women excluded based on the exclusion criteria. The exercise group attended a 60-min exercise class twice a week for 3 months. Falls, injuries, fractures, and functional fitness assessments were measured at baseline, post-intervention and 1-year follow up. During the follow up, fall rates were 19.6% in the exercise group, 40.4% in the education group and 40.8% in excluded subjects (χ(2) = 7.069, P = 0.029). Compared with the exercise group, the odds ratio (OR) for falls was greater in the education group (OR 2.78, 95% confidence interval (CI) 1.17-6.96) and excluded participants (OR 2.83, 95%CI 1.25-6.80). The OR for fractures was over fourfold greater in excluded participants (OR 4.30, 95% CI 1.02-9.70) than the exercise group. The exercise intervention for participants with fall history effectively decreased incidences of falls and fractures. However, fall and fracture rates in excluded people were high. Further research focusing on feasible countermeasures for falls in excluded people who are at high risk of fractures is required.

Fall Prevention in Community-Dwelling Older Adults

Which types of interventions reduce falls in older people living in the community? Fall-prevention exercise programs, usually including muscle strengthening and balance retraining, were associated with lower fall rates in community-dwelling older people whether or not individuals were selected on the basis of fall risk. Home safety interventions, vitamin D supplementation in people with lower vitamin D levels, and individually targeted multifactorial interventions were associated with fewer falls in community-dwelling people with risk factors for falling.

Muscular loading of joints triggers cellular secretion of PRG4 into the joint fluid

We developed a novel testing system that allows quantification of joint loading and permits analysis of changes in total protein and PRG4 contents in joint fluid of intact knees in live mice. A sequence of 15 repeat, isometric muscular contractions of “low” intensity (less than 50% of the maximal isometric muscular force), and “high” intensity (greater than 55% of maximal) were applied repeatedly (up to five times with a 15min rest between contractions) to the mouse knee.Increases in knee joint loading were accompanied with significant increases in total protein (p<0.0001) and PRG4 concentrations in the synovial fluid. Total protein and PRG4 concentrations decreased with repeated “high” intensity loading. However, the addition of cell secretion inhibitors to the knee prior to muscular loading resulted in PRG4 levels that remained below the detection limit for all loading conditions.These results suggest that changes in synovial fluid proteins and PRG4 concentrations upon joint loading are mediated by cells within the joint, and that these changes may be used as quantitative indicators for the intensity and duration of acute joint loading, and might serve as a powerful clinical tool to assess the effectiveness of rehabilitation and prevention exercise programs.

Characteristics of optimum falls prevention exercise programmes for community-dwelling older adults using the FITT principle

Abstract This review aims to identify the optimal exercise intervention characteristics for falls prevention among community-dwelling adults aged 60 years and over. Articles for inclusion were sourced by searching the Academic Search Premier, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE and SPORTDiscus databases with the key words ‘falls’, ‘prevention’, ‘exercise’ and ‘community’ and via reference lists of relevant articles. Only articles of level 1 or level 2 evidence (Howick et al. 2011) were included. Other inclusion criteria included recording falls incidence as an outcome measure, examining a community-dwelling population aged 60 years or over and implementing exercise as a single intervention in at least one group. Exercise programme characteristics from 31 articles were examined according to their frequency, intensity, time and type and their effects on falls incidence were reviewed. Exercising for a minimum of 1 h/week for at least 40 h over the course of an intervention is required to successfully reduce falls incidence. The optimal exercise frequency is three times per week, but the optimal duration per bout remains unclear. Specific balance training of sufficiently challenging intensity is a vital programme component, and strength training is most effective when combined with balance training. Flexibility and endurance training may also be included as part of a comprehensive programme. A combination of group and individual home exercise may be most effective for preventing falls and promoting exercise adherence.