Monat: September 2012

Interventions for the prevention of falls in older adults

aktivtraining Sturzprävention, Training im Alter, Wissenschaft , , ,

A systematic review and meta-analysis of randomised clinical trials

  1. John T Chang, clinical instructor (johnchang@mednet.ucla.edu)1,
  2. Sally C Morton, codirector2,
  3. Laurence Z Rubenstein, professor3,
  4. Walter A Mojica, physician reviewer2,
  5. Margaret Maglione, policy analyst2,
  6. Marika J Suttorp, quantitative analyst2,
  7. Elizabeth A Roth, senior programmer analyst2,
  8. Paul G Shekelle, professor1

 

 

  • Accepted 14 January 2004

Abstract

Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.

Components of multifactorial falls risk assessment

Design Systematic review and meta-analyses.

Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews.

Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education.

Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of falling (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82, 0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01;2.7).

Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling

Quelle / Full Text:

http://www.bmj.com/content/328/7441/680

Interventions for the prevention of falls in older adults ´pdf Download  – http://www.bmj.com/highwire/filestream/345710/field_highwire_article_pdf/0/680

 

 

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AGE-RELATED CHANGES OF POSTURAL STABILITY …….

aktivtraining Gesundheitstraining, Training im Alter , , , ,

……… AND PHYSICAL FUNCTION IN MIDDLE-AGED AND ELDERLY JAPANESE

RUMI KOZAKAI1), WATARU DOYO1), FUJIKO ANDO1), HIROSHI SHIMOKATA1)

1) Department of Epidemiology, National Institute for Longevity Sciences, National Center for Geriatrics and Gerontology : NILS/NCGG

Released on J-STAGE 20120927

Keywords: postural stability, abdominal muscle strength, gait performance, longitudinal study, middle-aged and elderly

ABSTRACT

The aim of the present study was to clarify the relationships between age-related changes of postural stability and physical function in middle-aged and elderly Japanese. The subjects were 640 males and 620 females who had participated in both the baseline and the 4-year follow-up surveys of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Postural stability was measured using a force platform. Flexibility, muscle function, reaction time, balance and comfortable and maximal gait performance were also measured as physical function. Postural sway was increased in 4 years. Multiple logistic regression analysis controlled for age, sex, height, weight and history of diseases revealed significant relationships between decline of postural stability and sit-ups, flexibility, frequency and velocity at comfortable gait and leg extension power at baseline. These results suggest that not only greater abdominal muscle strength and leg power but also quick walking benefit the preservation of postural stability.

Quelle:  https://www.jstage.jst.go.jp/article/jspfsm/55/Supplement/55_S227/_article

Full Text / pdf:  https://www.jstage.jst.go.jp/article/jspfsm/55/Supplement/55_S227/_pdf

 

 

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Relationships between Physical Activity, ADL Capability and Fall Risk ……

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…….. in Community-Dwelling Japanese Elderly Population

*Tomohisa YOKOYA1), *Shinichi DEMURA2), *Susumu SATO3)

1) Kaga City Hall, 2) Kanazawa University, Graduate School of Natural Science and Technology 3) Kanazawa Institute of Technology, Life-Long Sports Core

Released 2007/03/01

Keywords: fall risk, ADL, physical activity, frequency of leaving the house, Falling Assessment Chart

ABSTRACT

Objective: The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population.
Methods: The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence.
Results: Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score <5) had a significantly higher ADL capability than the group with a high fall risk (score ³5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk.
Conclusions: This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.

Quelle:   https://www.jstage.jst.go.jp/article/ehpm/12/1/12_1_25/_article

Full Text / pdf:  https://www.jstage.jst.go.jp/article/ehpm/12/1/12_1_25/_pdf

 

ADL = Activities of Daily Life

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Relationship between Muscular Strength of the Lower Extremities and Trunk Acceleration…..

aktivtraining Osteoporoseprävention, Sturzprävention , , , ,

…..during Backward Stepping by the Elderly

Yahiko Takeuchi1), Makoto Miwa2), Chikara Aoki3)

1) Department of Physical Therapy, Chiba Prefectural College of Allied Medical Science 2) Department of Rehabilitation, Chiba Prefectural University of Health Sciences 3) Department of Physical Therapy, Teikyo Heisei University

Released 2010/07/31

Keywords: Stepping reaction, Trunk acceleration, Muscular strength

ABSTRACT

[Purpose] The purpose of this study was to investigate the relationship between the muscular strength of the lower extremity and the trunk acceleration during a backward stepping reaction performed by the elderly.

[Subjects] The study population comprised 11 elderly subjects (average age, 75.5 ± 6.9 years). [Methods] Using a separation-type force plate and a small tri-axial accelerometer, we measured the vertical reaction force and the acceleration at the seventh cervical (C7) and the second sacral (S2) vertebrae in backward stepping reaction. Furthermore, we measured the muscular strength of the lower extremity using a hand-held dynamometer, and examined the relationship between the acceleration value of C7 and S2 and the muscular strength.

[Results] Correlation analysis revealed that the acceleration values of C7 and S2 showed significant positive correlations with the muscular strengths of the hamstrings, tibialis anterior, and triceps surae.

[Conclusion] These results suggest that the muscles controlling the dorsi/plantar flexion of the ankle and pelvic stability contribute to acceleration of the trunk in the backward stepping reaction.

Quelle:   https://www.jstage.jst.go.jp/article/jpts/22/2/22_2_167/_article

Full Text / pdf: https://www.jstage.jst.go.jp/article/jpts/22/2/22_2_167/_pdf

 

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Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention

aktivtraining Sturzprävention, Training im Alter , , ,
  1. Jung Hyun Choi PhD RN,
  2. Jung-Soon Moon PhD RN,
  3. Rhayun Song PhD RN

Article first published online: 17 JUN 2005

DOI: 10.1111/j.1365-2648.2005.03480.x

Journal of Advanced Nursing

Volume 51, Issue 2, pages 150–157, July 2005

Abstract:

Keywords:

  • fall avoidance efficacy;
  • falls;
  • nursing;
  • older adults;
  • physical fitness;
  • Tai Chi exercise

Aim.  This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme.

Background.  Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people.

Methods.  A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77·8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests.

Results.  At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0·001) and extensors (P < 0·01), and improved flexibility (P < 0·01) and mobility (P < 0·001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0·62. The experimental group reported significantly more confidence in fall avoidance than did the control group.

Conclusion.  The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.

 

Quelle:   http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2005.03480.x/abstract

 

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Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial

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  1. Ngaire Kerse MBChB, PhD,
  2. Meg Butler MPH,
  3. Elizabeth Robinson MSc,
  4. Maree Todd FRACP, MBChB

Article first published online: 30 MAR 2004

DOI: 10.1111/j.1532-5415.2004.52157.x

Journal of the American Geriatrics Society

Volume 52, Issue 4, pages 524–531, April 2004

 

Abstract:

Keywords:

  • fall prevention;
  • residential care;
  • cluster randomized controlled trial

Objectives: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents.

Design: Cluster, randomized, controlled trial.

Setting: Fourteen randomly selected residential care homes in Auckland, New Zealand.

Participants: All older residents (n=628, 95% participation rate).

Intervention: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks.

Measurements: Number of residents sustaining a fall, falls, and injurious-falls incidence rates.

Results: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06–1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.

Conclusion: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care.

Quelle:  http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2004.52157.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=true

 

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Effectiveness of Physical Training on Motor Performance and Fall Prevention in Cognitively Impaired Older Persons

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A Systematic Review /Hauer, K PhD; Becker, C MD, PhD; Lindemann, U PhD; Beyer, N PhD
Abstract:

Objective:

To determine whether older cognitively impaired people benefit from physical training with regard to motor performance or fall risk reduction and to critically evaluate the methodologic approach in identified randomized controlled intervention trials.

Design:

Published randomized controlled intervention trials from 1966 through 2004 were identified in PubMed, CINAHL, Gerolit, and the Cochrane Central Register of Controlled Trials according to predefined inclusion criteria and evaluated by two independent reviewers using a modified rating system for randomized controlled intervention trials developed by the Cochrane Library.

Results:

There were 11 randomized controlled intervention trials that met the predefined inclusion criteria. There was a large heterogeneity regarding methodology, sample size, type of intervention, study outcomes, and analyses. We found conflicting evidence regarding the effect of physical training on motor performance and falls in older people with cognitive impairment. However, a considerable number of the studies had methodologic limitations, which hampered the evaluation of the effectiveness of training.

Conclusions:

The randomized controlled intervention trials showed only limited effectiveness of physical training in patients with cognitive impairment. More studies with adequate sample size, sensitive and validated measurements, and higher specificity for the types of intervention targeting subgroups of patients with different degrees of cognitive impairment are required to give evidence-based recommendations.

Hauer K, Becker C, Lindemann U, Beyer N: Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons: A systematic review. Am J Phys Med Rehabil 2006;85:847-857.

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Resistance and Agility Training Reduce Fall Risk in Women Aged 75 to 85…..

aktivtraining Gesundheitstraining, Osteoporoseprävention, Sturzprävention , , ,

…… with Low Bone Mass: A 6-Month Randomized, Controlled Trial

  1. Teresa Liu-Ambrose PhD, PT1,2,
  2. Karim M. Khan MD, PhD1,2,7,
  3. Janice J. Eng PhD, PT/OT3,7,
  4. Patti A. Janssen PhD1,5,
  5. Stephen R. Lord PhD5,
  6. Heather A. Mckay PhD1,4,6

Article first published online: 14 APR 2004

DOI: 10.1111/j.1532-5415.2004.52200.x

Abstract:

Keywords:

  • accidental falls;
  • fall risk;
  • exercise;
  • aged;
  • low bone mass

Objectives: To compare the effectiveness of group resistance and agility-training programs in reducing fall risk in community-dwelling older women with low bone mass.

Design: A randomized, controlled, single-blind 25-week prospective study with assessments at baseline, midpoint, and trial completion.

Setting: Community center.

Participants: Community-dwelling women aged 75 to 85 with low bone mass.

Intervention: Participants were randomly assigned to one of three groups: resistance training (n=32), agility training (n=34), and stretching (sham) exercises (n=32). The exercise classes for each study arm were held twice weekly.

Measurements: The primary outcome measure was fall risk (derived from weighted scores from tests of postural sway, reaction time, strength, proprioception, and vision), as measured using a Physiological Profile Assessment (PPA). Secondary outcome measures were ankle dorsiflexion strength, foot reaction time, and Community Balance and Mobility Scale score.

Results: Attendance at the exercise sessions for all three groups was excellent: resistance training (85.4%), agility training (87.3%), and stretching program (78.8%). At the end of the trial, PPA fall-risk scores were reduced by 57.3% and 47.5% in the resistance and agility-training groups, respectively, but by only 20.2% in the stretching group. In the resistance and agility groups, the reduction in fall risk was mediated primarily by improved postural stability, where sway was reduced by 30.6% and 29.2%, respectively. There were no significant differences between the groups for the secondary outcomes measures. Within the resistance-training group, reductions in sway were significantly associated with improved strength, as assessed using increased squat load used in the exercise sessions.

Conclusion: These findings support the implementation of community-based resistance and agility-training programs to reduce fall risk in older women with low bone mass. Such programs may have particular public health benefits because it has been shown that this group is at increased risk of falling and sustaining fall-related fractures.

Quelle:  http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2004.52200.x/abstract

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Effects of Maximal Isometric and Isokinetic Resistance Training on Strength

aktivtraining Gesundheitstraining, Osteoporoseprävention, Training im Alter , , ,

Effects of Maximal Isometric and Isokinetic Resistance Training on Strength and Functional Mobility in Older Adults

Abstract

Background. The aim of the present study was to compare the changes in voluntary strength (isometric, concentric, and eccentric) and functional mobility in response to maximal isokinetic eccentric-only resistance training to those elicited by maximal isometric-only or maximal isokinetic concentric-only resistance training in older adults.

Methods. Twelve women (73 ± 7 years) and 18 men (73 ± 5 years) completed a 12-week training program (three times per week) using a Biodex System 3 dynamometer. Primary outcome measures included peak isometric and isokinetic (concentric and eccentric) knee extensor strength, concentric work, concentric power, stair ascent and descent, and gait speed. Participants were randomly assigned to one of three training groups: isometric-only, isokinetic concentric-only, or isokinetic eccentric-only.

Results. All three training groups demonstrated an increase in peak isometric and isokinetic concentric and eccentric strength following 12 weeks of training (p <.01). Step time was positively influenced (p <.03) by all three training modes; however, gait speed was unchanged following 12 weeks of training. All three training groups experienced a significant increase in peak concentric work and concentric power (p <.01) with the concentric training group demonstrating the largest increases in both peak concentric work and concentric power when compared to the isometric and eccentric training groups.

Conclusions. It was clear that all three resistance training programs (isometric, concentric, and eccentric) in older adults were effective in increasing strength, concentric work, and concentric power over the 12-week training period. Furthermore, 12 weeks of resistance training resulted in improved stair ascent and descent performance.

Quelle:   http://biomedgerontology.oxfordjournals.org/content/60/6/777.short

 

 

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Effects of resistance training on strength,……

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Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older.

Abstract:

OBJECTIVE: To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over.

DESIGN: Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group.

SETTING: The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London.

PARTICIPANTS: Fifty-two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre- and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years).

INTERVENTIONS: Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1-1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls.

MEASUREMENTS: Pre- and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118-m self-paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre- and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one-sided Fishers exact test (2 x 2 table) for discontinuous data.

RESULTS: Improvements in IKES (mean change 27%, P =.03), IEFS (22%, P =.05), HGS (4%, P =.05), LEP/kg (18%, P =.05) were associated with training, but the improvement in LEP (18%, P =.11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%, P =.02) and a small improvement in step up height (median 5%, P =.005). The other functional tests did not improve.

CONCLUSIONS: Progressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent, very old women.

Quelle:  http://ukpmc.ac.uk/abstract/MED/7560695/reload=0;jsessionid=ymFQOY4OybBrjoszGAUY.0

 

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